Exploiting smart e-Health gateways at the edge of healthcare Internet-of-Things

Background Although rapid response teams (RRTs) increasingly have been adopted by hospitals, their effectiveness in reducing hospital mortality remains uncertain. We conducted a meta-analysis to assess the effect of RRTs on reducing cardiopulmonary arrest and hospital mortality rates. Methods We conducted a systematic review of studies published from January 1, 1950, through November 31, 2008, using PubMed, EMBASE, Web of Knowledge, CINAHL, and all Evidence-Based Medicine Reviews. Randomized clinical trials and prospective studies of RRTs that reported data on changes in the primary outcome of hospital mortality or the secondary outcome of cardiopulmonary arrest cases were included. Results Eighteen studies from 17 publications (with 1 treated as 2 separate studies) were identified, involving nearly 1.3 million hospital admissions. Implementation of an RRT in adults was associated with a 33.8% reduction in rates of cardiopulmonary arrest outside the intensive care unit (ICU) (relative risk [RR], 0.66; 95% confidence interval [CI], 0.54-0.80) but was not associated with lower hospital mortality rates (RR, 0.96; 95% CI, 0.84-1.09). In children, implementation of an RRT was associated with a 37.7% reduction in rates of cardiopulmonary arrest outside the ICU (RR, 0.62; 95% CI, 0.46-0.84) and a 21.4% reduction in hospital mortality rates (RR, 0.79; 95% CI, 0.63-0.98). The pooled mortality estimate in children, however, was not robust to sensitivity analyses. Moreover, studies frequently found evidence that deaths were prevented out of proportion to reductions in cases of cardiopulmonary arrest, raising questions about mechanisms of improvement. Conclusion Although RRTs have broad appeal, robust evidence to support their effectiveness in reducing hospital mortality is lacking.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/481530/ira90009_18_26.pdf

Rapid Response Teams: A Systematic Review and Meta-analysis.

Rapid-response teams aim to care for inpatients in whom acute respiratory, neurologic, or cardiac insufficiency is developing. This review describes the prevalence and consequences of sudden critical illness outside the ICU and discusses the rationale for rapid-response systems.

Rapid-Response Teams

Objectives:To update the Society of Critical Care Medicine’s guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research.Design:An appointed Task Force followed a standard, systematic, and evidence-

ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research.

The impact of the use of the Early Warning Score (EWS) on patient outcomes: A systematic review

Background
Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence.

Objectives
The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events.

Search methods
The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information.

Selection criteria
Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review.

Data collection and analysis
Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study.

Main results
Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group.

Authors' conclusions
The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.

Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

Cochrane Systematic Review of Critical Care Outreach services (CCOS) and Medical Emergency Teams (MET).

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Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

Cochrane Systematic Review of Critical Care Outreach services (CCOS) and Medical Emergency Teams (MET).