Authors: Ono, Shohei et al.
Anesthesiology, July 30, 2025. DOI: 10.1097/ALN.0000000000005689
This multicenter retrospective study evaluated how differences in ICU admission practices after Rapid Response System (RRS) activation influence patient outcomes across Japanese hospitals. RRS programs are designed to identify and manage deteriorating inpatients early, but ICU transfer rates following activation vary considerably between institutions, raising questions about optimal utilization.
Data were drawn from a national in-hospital emergency registry spanning 2018–2022, including 8,794 patients from 35 hospitals. For each institution, researchers calculated both the ICU admission rate (ICU admissions divided by RRS activations) and the Standardized ICU Admission Ratio (SIAR), defined as the observed-to-predicted ICU admission ratio adjusted for case mix. They then analyzed associations between SIAR and patient outcomes using multilevel regression models accounting for hospital-level clustering.
Across hospitals, the median ICU admission rate was 0.33 (IQR 0.21–0.47), and the median SIAR was 0.98 (IQR 0.75–1.17), indicating wide institutional variability. In multivariable analysis, higher SIAR values—representing greater ICU utilization than expected—were significantly associated with a lower incidence of poor neurological outcome or death within 30 days (odds ratio 0.94 per 0.1-unit increase; 95% CI 0.92–0.96; P<0.001). Although the association with mortality alone did not reach statistical significance, the trend favored improved outcomes with higher ICU admission rates.
These results suggest that hospitals admitting a higher proportion of RRS-activated patients to the ICU may achieve better short-term neurologic and survival outcomes. The mechanisms may include earlier stabilization, more intensive monitoring, and better access to critical interventions.
What You Should Know:
Hospitals with higher-than-expected ICU admission rates after RRS activation experienced lower rates of severe neurologic impairment and death. These findings support proactive ICU transfer policies for patients identified by RRS teams, emphasizing the potential life-saving impact of timely escalation.
Thank you to Anesthesiology for publishing this important multicenter analysis advancing understanding of how ICU resource utilization affects patient outcomes after in-hospital emergencies.