Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital
Bibliographic record
Abstract
Background . Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives . A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system’s impact on time to intervention, code blue rates, and ICU transfer rates. Results . Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10), compared to 3.4 hours (IQR 0.6–12.4) before system implementation (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>p</mml:mi><mml:mo><</mml:mo><mml:mn fontstyle="italic">0.001</mml:mn></mml:math>). Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mo>±</mml:mo><mml:mn fontstyle="italic">2.2</mml:mn></mml:math>) before intervention to 3.3/1000 patient days (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mo>±</mml:mo><mml:mn fontstyle="italic">1.4</mml:mn></mml:math>) after intervention (IRR: 0.82,<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.04</mml:mn></mml:math>(CI 95%: 0.69–0.99)). CTU code blue rates decreased from 2.2/1000 patient days (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mo>±</mml:mo><mml:mn fontstyle="italic">1.6</mml:mn></mml:math>) before intervention to 1.2/1000 patient days (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mo>±</mml:mo><mml:mn fontstyle="italic">1.3</mml:mn></mml:math>) after intervention (IRR: 0.51,<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.02</mml:mn></mml:math>(CI 95%: 0.30–0.89)). Conclusion . Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".