Rapid Response System Escalation During Recovery of Hospital Bed Occupancy: An Observational Longitudinal Study.
8 affiliations
- 1Intensive Care Unit, Institute of Science Tokyo Hospital, Tokyo, Japan.
- 2Department of Disaster and Critical Care Nursing, Track of Nursing Innovation Science, Graduate School of Health Care Sciences Institute of Science Tokyo, Tokyo, Japan.
- 3Division of Clinical Management, Medical Informatics, Institute of Science Tokyo Hospital, Tokyo, Japan.
- 4Department of Biostatistics, M&D Data Science Center, Institute of Science Tokyo, Tokyo, Japan.
- 5Department of Nursing, Institute of Science Tokyo Hospital, Tokyo, Japan.
- 6Department of Insured Medical Care Management, Institute of Science Tokyo Hospital, Tokyo, Japan.
- 7Quality Management Centre, Institute of Science Tokyo, Tokyo, Japan.
- 8Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences Institute of Science Tokyo, Tokyo, Japan.
Abstract
Background
Early warning scores (EWS) identify patient deterioration, but their impact depends on how they are integrated into workflows and escalation culture, particularly as hospitals recover from pandemic-related bed pressures.Aims
To evaluate changes in rapid response system (RRS) escalation processes and rare safety outcomes after embedding an EWS within proactive Critical Care Outreach Team (CCOT) rounds as hospital bed occupancy recovered.Study design
Observational longitudinal study at a single tertiary hospital in Japan comparing one pre-intervention year (2021) with three post-intervention years (2022-2024). In January 2022, a standardised EWS was embedded into proactive CCOT rounds and used as a prompt for shared clinical reasoning rather than a strict numeric trigger. Monthly aggregated ward-level data were analysed using Poisson regression, adjusting for seasonality, patient characteristics and bed occupancy.Results
Across 71 985 admissions and 692 942 general-ward patient-days, rates of nurse-initiated escalations, RRS activations and resuscitation-status updates per 1000 patient-days increased in post-intervention analyses, but these differences were attenuated after full adjustment. In fully adjusted models, post-intervention incidence rate ratios (IRRs) were close to 1.0 for all process outcomes. For nurse-initiated escalations, IRRs ranged from 0.94 to 1.14, and all 95% confidence intervals included 1.0. Rates of unexpected in-hospital cardiac arrest and unplanned ICU admission remained low and stable. Bed occupancy increased over the study period, but within-year associations with outcomes were weak.Conclusions
After adjustment for patient characteristics and hospital bed occupancy, embedding an EWS within proactive CCOT rounds was associated with broadly stable escalation process indicators and no clear evidence of deterioration in rare safety outcomes.Relevance to clinical practice
These findings suggest that approaches to the RRS afferent limb that embed EWS use within structured dialogue between ward nurses and outreach teams may provide one plausible mechanism for sustaining escalation behaviours under operational pressure.
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BibTeX
@article{noguchi2026rapid,
title = {{Rapid Response System Escalation During Recovery of Hospital Bed Occupancy: An Observational Longitudinal Study.}},
author = {Ayako Noguchi and Tomoaki Yamada and Tatsuhiko Anzai and Kouji Oka and Masumi Ai and Yuji Uchimura and Mikayo Toba and Kunihiko Takahashi and Mutsuko Moriwaki and Kenji Wakabayashi},
journal = {Nursing in critical care},
year = {2026},
month = oct,
doi = {10.1111/nicc.70761},
url = {https://europepmc.org/article/MED/42952268},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Rapid Response System Escalation During Recovery of Hospital Bed Occupancy: An Observational Longitudinal Study.
AU - Ayako Noguchi
AU - Tomoaki Yamada
AU - Tatsuhiko Anzai
AU - Kouji Oka
AU - Masumi Ai
AU - Yuji Uchimura
AU - Mikayo Toba
AU - Kunihiko Takahashi
AU - Mutsuko Moriwaki
AU - Kenji Wakabayashi
PY - 2026
DA - 2026/10/28
JO - Nursing in critical care
DO - 10.1111/nicc.70761
UR - https://europepmc.org/article/MED/42952268
AB - Background Early warning scores (EWS) identify patient deterioration, but their impact depends on how they are integrated into workflows and escalation culture, particularly as hospitals recover from pandemic-related bed pressures.Aims To evaluate changes in rapid response system (RRS) escalation processes and rare safety outcomes after embedding an EWS within proactive Critical Care Outreach Team (CCOT) rounds as hospital bed occupancy recovered.Study design Observational longitudinal study at a single tertiary hospital in Japan comparing one pre-intervention year (2021) with three post-intervention years (2022-2024). In January 2022, a standardised EWS was embedded into proactive CCOT rounds and used as a prompt for shared clinical reasoning rather than a strict numeric trigger. Monthly aggregated ward-level data were analysed using Poisson regression, adjusting for seasonality, patient characteristics and bed occupancy.Results Across 71 985 admissions and 692 942 general-ward patient-days, rates of nurse-initiated escalations, RRS activations and resuscitation-status updates per 1000 patient-days increased in post-intervention analyses, but these differences were attenuated after full adjustment. In fully adjusted models, post-intervention incidence rate ratios (IRRs) were close to 1.0 for all process outcomes. For nurse-initiated escalations, IRRs ranged from 0.94 to 1.14, and all 95% confidence intervals included 1.0. Rates of unexpected in-hospital cardiac arrest and unplanned ICU admission remained low and stable. Bed occupancy increased over the study period, but within-year associations with outcomes were weak.Conclusions After adjustment for patient characteristics and hospital bed occupancy, embedding an EWS within proactive CCOT rounds was associated with broadly stable escalation process indicators and no clear evidence of deterioration in rare safety outcomes.Relevance to clinical practice These findings suggest that approaches to the RRS afferent limb that embed EWS use within structured dialogue between ward nurses and outreach teams may provide one plausible mechanism for sustaining escalation behaviours under operational pressure.
SN - 1362-1017
SN - 1478-5153
ER -