Characteristics of In-Hospital Patients with Congenital Heart Disease Requiring Rapid Response System Activations: A Japanese Database Study

Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.

Recognizing Early Warning Signs (EWS) in Patients Is Critically Important

Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases;these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning signs.

COVID-19 contact tracing in a tertiary care hospital: A retrospective chart review

Background:Contact tracing is one of the strategies used to control COVID-19 pandemic.It played an important role in the beginning to identify all contacts and minimise the spread of the infection.Methods:A retrospective chart review was carried out of contact tracing records during the one-month period,starting from the onset of the first lockdown in India.The largest wave of 372 contacts was analysed in detail to find out the association between the result of COVID-19 test and various factors(age,gender,type of contact).Results:A total of 372 contacts(214 males and 158 females)were traced and around 21%contacts were tested positive on COVID-19 RT-PCR test.Chi-square test didn’t find the significant difference between COVID-19 test result and proportions of male and female contacts,X^(2)(1)0.033,p=0.855.Female positive contacts had lower mean age compared to male positive contacts,though not statistically significant,t(75)=-1.809,p=0.0745.No difference was found in either median or mean age of contacts with respect to COVID-19 test result.Odds of tested COVID-19 positive among household contacts much higher than community contacts,OR=24.52,95%CI 12.45e48.29,p<0.05.Conclusion:No difference was noted in the rate of contracting infection with respect to age and gender of contacts.Type of contact,household or community,significantly affected the probability of becoming infected with the coronavirus.Occupation of primary case was probably responsible for large number of contacts found positive for COVID-19.