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2026, Number 4

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Med Crit 2026; 40 (4)

Rapid response team, NEWS score and clinical telemetry: experience at a Tertiary Hospital in Mexico

Sansón TAP, Sánchez ZJJ

Language: Spanish
References: 19
Page: 294-300
PDF size: 810.14 Kb.


ABSTRACT

Introduction: in-hospital clinical deterioration is frequent and potentially preventable. Rapid response teams (RRT) and the National Early Warning Score (NEWS) aim to detect it in a timely manner. Objective: to validate the NEWS score and assess the impact of an RRT and a clinical telemetry system in a tertiary hospital in Mexico. Material and methods: retrospective observational study. Pilot cohort (March 2021-April 2023, n = 81): logistic regression and ROC curves. Full cohort (March 2021-February 2025) and Aidicare telemetry (2023-March 2025). Results: NEWS independently predicted mortality (OR 1.215; 95%CI 1.020-1.448, p = 0.029), Intensive Care Unit (ICU) transfer (OR 1.294, p = 0.013), invasive mechanical ventilation (OR 1.366, p = 0.006) and vasopressor use (OR 1.193, p = 0.032); best AUC for mechanical ventilation (0.781; cutoff > 8). Activation causes: hypotension (41.1%) and respiratory deterioration (26.5%); 58% transferred to step-down unit, 23% to ICU; overall mortality 20%. Relative reduction of 30.5% in code-blue events (RR 0.69; 95%CI 0.46-1.03, p = 0.077). The telemetry system performed 468,420 NEWS assessments in 26,104 patients, with 11,198 severe-risk events and a Number Needed to Evaluate of 53. Conclusions: integrating NEWS, clinical telemetry and an RRT allowed the detection and risk-stratification of clinical deterioration while optimizing the balance between clinical benefit and resource use.


REFERENCES

  1. Hodgetts TJ, Kenward G, Vlachonikolis IG, Payne S, Castle N.The identification of risk factors for cardiac arrest and formulationof activation criteria to alert a medical emergency team.Resuscitation. 2002;54(2):125-131.

  2. Lyons PG, Edelson DP, Churpek MM. Rapid response systems.Resuscitation. 2018;128:191-197.

  3. Buist M, Bernard S, Nguyen TV, Moore G, Anderson J.Association between clinically abnormal observationsand subsequent in-hospital mortality: a prospective study.Resuscitation. 2004;62(2):137-141.

  4. Devita MA, Bellomo R, Hillman K, et al. Findings of the firstconsensus conference on medical emergency teams. Crit CareMed. 2006;34(9):2463-78.

  5. Joint Commission International. Accreditation Standardsfor Hospitals. 7th ed. Oakbrook Terrace: Joint CommissionInternational; 2020.

  6. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. NEngl J Med. 2011;365(2):139-146.

  7. Lee A, Bishop G, Hillman KM, Daffurn K. The medical emergencyteam. Anaesth Intensive Care. 1995;23(2):183-186.

  8. DeVita MA, Smith GB, Adam SK, et al. “Identifying thehospitalised patient in crisis”–a consensus conference onthe afferent limb of rapid response systems. Resuscitation.2010;81(4):375-382.

  9. Hillman K, Chen J, Cretikos M, et al. Introduction of the medicalemergency team (MET) system: a cluster-randomised controlledtrial. Lancet. 2005;365(9477):2091-2097.

  10. Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M,Spertus JA. Hospital-wide code rates and mortality beforeand after implementation of a rapid response team. JAMA.2008;300(21):2506-2513.

  11. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S,Pronovost PJ. Rapid response systems: a systematic review.Crit Care Med. 2007;35(5):1238-1243.

  12. Maharaj R, Raffaele I, Wendon J. Rapid response systems: asystematic review and meta-analysis. Crit Care. 2015;19(1):254.

  13. Al-Omari A, Al Mutair A, Aljamaan F. Outcomes of rapid responseteam implementation in tertiary private hospitals: a prospectivecohort study. Int J Emerg Med. 2019;12(1):31.

  14. Solomon RS, Corwin GS, Barclay DC, Quddusi SF, DannenbergMD. Effectiveness of rapid response teams on rates of in-hospitalcardiopulmonary arrest and mortality: a systematic review andmeta-analysis. J Hosp Med. 2016;11(6):438-445.

  15. Chen J, Bellomo R, Flabouris A, Hillman K, Finfer S; MERITStudy Investigators. The relationship between early emergencyteam calls and serious adverse events. Crit Care Med.2009;37(1):148-153.

  16. Smith GB, Prytherch DR, Meredith P, Schmidt PE, FeatherstonePI. The ability of the National Early Warning Score (NEWS) todiscriminate patients at risk of early cardiac arrest, unanticipatedintensive care unit admission, and death. Resuscitation.2013;84(4):465-470.Tabla 3: Resumen anual del sistema de telemetría clínica con escala NEWS.AñoEvaluacionesnPacientesn Eval/pacienteRiesgo leveNEWS 0-4n (%)Riesgo moderadoNEWS 5-6n (%)Riesgo severoNEWS > 6n (%)2023 209,047 12,316 16.97 185,700 (88.83) 28,163 (13.47) 5,182 (2.48)2024 220,052 11,810 18.63 186,167 (84.6) 28,816 (13.1) 5,064 (2.3)2025 (ene-feb) 39,321 1,978 19.87 32,998 (83.92) 5,369 (13.65) 952 (2.42)NEWS = National Early Warning Score (Puntuación Nacional de Alerta Temprana).Sistema Aidicare-Telemetría Base. Hospital Médica Sur, 2023-marzo 2025.

  17. Chen J, Ou L, Hillman K, et al. The impact of implementing arapid response system: a comparison of cardiopulmonaryarrests and mortality among four teaching hospitals in Australia.Resuscitation. 2014;85(9):1275-1281.

  18. Hall KK, Lim A, Gale B. The use of rapid response teams toreduce failure to rescue events: a systematic review. J PatientSaf. 2020;16(3S Suppl 1):S3-S7.

  19. Monares Zepeda E, Galindo CA, Aguirre Sánchez JS, FrancoGranillo J. Equipo de respuesta rápida: utilidad y desempeñoen un Hospital de Tercer Nivel. Med Crit. 2017;31(4):195-201.https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0187-84332016000100005




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