Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa
AimLittle is known about the incidence of clinical deterioration and cardiopulmonary arrest (CPA) on general hospital units in low-and middle-income countries (LMICs) or how rapid response systems (RRSs) might impact these events. Implementation of RRSs in high-income countries has been shown to red...
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| Format: | Article |
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1583470/full |
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| author | Promise Ariyo Seung W. Lee Asad Latif Chinyere Egbuta Vinciya Pandian Olufemi Bankole Ibironke Desalu John Sampson Bradford Winters |
| author_facet | Promise Ariyo Seung W. Lee Asad Latif Chinyere Egbuta Vinciya Pandian Olufemi Bankole Ibironke Desalu John Sampson Bradford Winters |
| author_sort | Promise Ariyo |
| collection | DOAJ |
| description | AimLittle is known about the incidence of clinical deterioration and cardiopulmonary arrest (CPA) on general hospital units in low-and middle-income countries (LMICs) or how rapid response systems (RRSs) might impact these events. Implementation of RRSs in high-income countries has been shown to reduce the incidence of CPA and mortality. The aim of this study was to determine whether implementation of an RRS is feasible in an LMIC medical center.MethodsWe developed and implemented an RRS in a large academic medical center in Lagos, Nigeria, in three phases: (1) Needs assessment and stakeholder engagement, (2) Infrastructure setup and education, and (3) Implementation and data collection. We collected data on incidence of rapid response events, attendance ratio and time of arrival of the designated clinical staff, triggers for the rapid response calls and common interventions at the events.ResultsOver the 7 months study period, 997 patients were admitted to the intervention-eligible units, and 95 RRS events occurred in 55 patients. In 11 RRS activations (11.6%), no rapid response team member responded. Anesthesia residents attended 73.7% of the events, and anesthesia techs and nurses attended roughly 38% each. Internal medicine residents responded to 13.7% of RRS activations. The average time to arrival was 13 min. The most common trigger was altered mental status, followed by hypoxia and hypotension. Seventy-six percent of patients survived their initial RRS activation, and 83% died while in hospital. Common interventions were vasopressor use, oxygen supplementation, and intravenous fluid administration. No patient was transferred to the designated intensive care unit after an RRS activation owing to lack of beds. Six patients were transferred to the makeshift ICU, all of which required vasopressor support.ConclusionWhile barriers remain, the development and implementation of an RRS program in an LMIC medical center is feasible. |
| format | Article |
| id | doaj-art-321d08de7b9b4fec96e867f347d09b94 |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-321d08de7b9b4fec96e867f347d09b942025-08-20T03:17:24ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.15834701583470Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan AfricaPromise Ariyo0Seung W. Lee1Asad Latif2Chinyere Egbuta3Vinciya Pandian4Olufemi Bankole5Ibironke Desalu6John Sampson7Bradford Winters8Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United StatesDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United StatesDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United StatesDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, United StatesSchool of Nursing, Johns Hopkins University, Baltimore, MD, United StatesDepartment of Surgery, University of Lagos College of Medicine, Lagos, Lagos, NigeriaDepartment of Anesthesiology, University of Lagos College of Medicine, Lagos, Lagos, NigeriaDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United StatesDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United StatesAimLittle is known about the incidence of clinical deterioration and cardiopulmonary arrest (CPA) on general hospital units in low-and middle-income countries (LMICs) or how rapid response systems (RRSs) might impact these events. Implementation of RRSs in high-income countries has been shown to reduce the incidence of CPA and mortality. The aim of this study was to determine whether implementation of an RRS is feasible in an LMIC medical center.MethodsWe developed and implemented an RRS in a large academic medical center in Lagos, Nigeria, in three phases: (1) Needs assessment and stakeholder engagement, (2) Infrastructure setup and education, and (3) Implementation and data collection. We collected data on incidence of rapid response events, attendance ratio and time of arrival of the designated clinical staff, triggers for the rapid response calls and common interventions at the events.ResultsOver the 7 months study period, 997 patients were admitted to the intervention-eligible units, and 95 RRS events occurred in 55 patients. In 11 RRS activations (11.6%), no rapid response team member responded. Anesthesia residents attended 73.7% of the events, and anesthesia techs and nurses attended roughly 38% each. Internal medicine residents responded to 13.7% of RRS activations. The average time to arrival was 13 min. The most common trigger was altered mental status, followed by hypoxia and hypotension. Seventy-six percent of patients survived their initial RRS activation, and 83% died while in hospital. Common interventions were vasopressor use, oxygen supplementation, and intravenous fluid administration. No patient was transferred to the designated intensive care unit after an RRS activation owing to lack of beds. Six patients were transferred to the makeshift ICU, all of which required vasopressor support.ConclusionWhile barriers remain, the development and implementation of an RRS program in an LMIC medical center is feasible.https://www.frontiersin.org/articles/10.3389/fmed.2025.1583470/fullPilot hospital-basedmultidisciplinaryrapid response systemfailure to rescue |
| spellingShingle | Promise Ariyo Seung W. Lee Asad Latif Chinyere Egbuta Vinciya Pandian Olufemi Bankole Ibironke Desalu John Sampson Bradford Winters Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa Frontiers in Medicine Pilot hospital-based multidisciplinary rapid response system failure to rescue |
| title | Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa |
| title_full | Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa |
| title_fullStr | Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa |
| title_full_unstemmed | Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa |
| title_short | Development, implementation, and evaluation of a rapid response system at a Nigerian teaching hospital, a novel idea in sub-Saharan Africa |
| title_sort | development implementation and evaluation of a rapid response system at a nigerian teaching hospital a novel idea in sub saharan africa |
| topic | Pilot hospital-based multidisciplinary rapid response system failure to rescue |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1583470/full |
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