Journal of multidisciplinary healthcare · 2026
Characteristics and Outcomes of Rapid Response System Activations in Obstetric Patients: A Multicenter Registry-Based Study in Japan.
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Nakai Toshihiro, Tamura Tetsuya, Tsuji Tatsuya, Nakanishi Toshiyuki, Kamimura Yuji, Sento Yoshiki, Tanaka Motoshi, Sobue Kazuya
Аннотация
OBJECTIVE: Maternal clinical deterioration during the perinatal period remains a major safety concern. Rapid response systems (RRSs) facilitate early recognition and intervention for clinical deterioration; however, evidence regarding obstetric RRS activations is limited. This study examined the characteristics and outcomes of obstetric RRS activations using a multicenter registry in Japan.
METHODS: This retrospective cohort study analyzed patients with RRS activation in the In-Hospital Emergency Registry in Japan (52 hospitals; November 2017-August 2024). Obstetric patients were defined as those pregnant or within 1 week postpartum at RRS activation. We evaluated patient characteristics, activation patterns, triggers, interventions, causes of deterioration, and outcomes in obstetric patients. Obstetric and non-obstetric patients (all other patients in the cohort) were also compared to identify differences in activation patterns, triggers, and interventions.
RESULTS: Among 16,125 patients with RRS activation, 141 (0.9%) were obstetric patients (median age, 34 years). Obstetric RRS activations were more frequently physician-initiated (31.8% vs 18.1%) and occurred more often during nighttime (17:00-7:59; 47.1% vs 32.9%) than non-obstetric activations. Common triggers for obstetric RRS activations were decreased consciousness (34.0%), massive bleeding (31.2%), and hypotension (29.8%), each more frequent than in non-obstetric activations (26.0%, 2.4%, and 22.3%, respectively). Common interventions in obstetric activations were diagnostic testing (39.6%), fluid bolus (36.4%), and oxygen administration (34.5%); fluid bolus (36.4% vs 19.2%) and transfusion (20.7% vs 2.9%) were performed more frequently than in non-obstetric activations. Among obstetric patients, massive hemorrhage was the leading cause of deterioration (39.0%); 29.1% were admitted to the intensive care unit, and no deaths occurred.
CONCLUSION: Obstetric RRS activations were most often triggered by decreased consciousness, massive bleeding, and hypotension, with massive hemorrhage as the predominant cause of deterioration. These findings provide a detailed characterization of obstetric RRS activations and may inform rapid response practices and patient safety approaches in obstetric care.
METHODS: This retrospective cohort study analyzed patients with RRS activation in the In-Hospital Emergency Registry in Japan (52 hospitals; November 2017-August 2024). Obstetric patients were defined as those pregnant or within 1 week postpartum at RRS activation. We evaluated patient characteristics, activation patterns, triggers, interventions, causes of deterioration, and outcomes in obstetric patients. Obstetric and non-obstetric patients (all other patients in the cohort) were also compared to identify differences in activation patterns, triggers, and interventions.
RESULTS: Among 16,125 patients with RRS activation, 141 (0.9%) were obstetric patients (median age, 34 years). Obstetric RRS activations were more frequently physician-initiated (31.8% vs 18.1%) and occurred more often during nighttime (17:00-7:59; 47.1% vs 32.9%) than non-obstetric activations. Common triggers for obstetric RRS activations were decreased consciousness (34.0%), massive bleeding (31.2%), and hypotension (29.8%), each more frequent than in non-obstetric activations (26.0%, 2.4%, and 22.3%, respectively). Common interventions in obstetric activations were diagnostic testing (39.6%), fluid bolus (36.4%), and oxygen administration (34.5%); fluid bolus (36.4% vs 19.2%) and transfusion (20.7% vs 2.9%) were performed more frequently than in non-obstetric activations. Among obstetric patients, massive hemorrhage was the leading cause of deterioration (39.0%); 29.1% were admitted to the intensive care unit, and no deaths occurred.
CONCLUSION: Obstetric RRS activations were most often triggered by decreased consciousness, massive bleeding, and hypotension, with massive hemorrhage as the predominant cause of deterioration. These findings provide a detailed characterization of obstetric RRS activations and may inform rapid response practices and patient safety approaches in obstetric care.