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All Journal Jurnal Anestesiologi Indonesia Jurnal PAJAR (Pendidikan dan Pengajaran) Bioscientia Medicina : Journal of Biomedicine and Translational Research Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Teknik Informatika (JUTIF) Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC)
Firdaus, Riyadh
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Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Rapid Response Systems as Secondary Responders to In-Hospital Clinical Deterioration: A Four-Year Observational Study Manggala, Sidharta Kusuma; Ramlan, Andi Ade Wijaya; Aditianingsih, Dita; Firdaus, Riyadh; Cahyadi, Arief; Auerkari, Aino Nindya; Hafidz, Noor; Parasian, Luther Holan; Sugiarto, Adhrie; Devina, Yoan; Mujono, Aivi; Cresma, Avisa Cetta
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.80762

Abstract

Background: In-hospital cardiac arrest (IHCA) is a major cause of preventable inpatient mortality, especially in low- and middle-income countries (LMICs) where rapid response systems (RRS) are still developing. Evidence regarding RRS performance in Indonesia is limited. This study evaluated the performance and operational challenges of an institutional RRS over four years at a large tertiary referral hospital in Jakarta.Objective: This study aimed to determine the proportion of immediate survival following RRS activation and to investigate secondary outcomes, including the association between activation indications and mortality, and system-level barriers.Methods: This retrospective observational cohort study included all inpatient RRS activations at Cipto Mangunkusumo National General Hospital (RSCM), Jakarta, Indonesia, from January 1, 2021, to December 31, 2024. Data from the hospital’s RRS registry were analyzed for activation triggers, interventions, immediate outcomes, and operational issues.Results: Among 246,367 inpatient admissions, there were 5,900 eligible inpatient RRS activations, yielding an activation rate of 23.9 per 1,000 admissions. Immediate survival occurred in 4,763 (80.7%) events, while 1,137 (19.3%) patients did not survive. Cardiac arrest (8.0%) and respiratory arrest (6.5%) were the strongest predictors of non-survival odds ratio (OR) 48.17 and 27.13 vs. red early warning score (EWS) reference, both p<0.001). Most activations occurred out of hours (63.0%), and mortality was significantly higher (71.3% vs. 61.1%; p < 0.001). The most frequent single-parameter triggers were oxygen saturation ≤90% (38.5%) and sudden deterioration of consciousness (15.8%). Mismatched activations, where the patient’s condition upon team arrival differed from the activation indicationwere strongly associated with higher mortality (OR 17.3, 95% confidence interval (CI) 14.3–20.2, p<0.001).Conclusion: The institutional RRS demonstrated a moderate activation rate and favorable immediate survival compared with similar LMIC settings. However, outcomes were influenced by delayed recognition, out-of-hours activation, and limited critical-care capacity. Strengthening early-escalation culture, monitoring afferent-limb failure (ALF), expanding nighttime coverage, and increasing intensive care unit (ICU) capacity are essential to enhance RRS effectiveness and reduce preventable in-hospital mortality in resource-limited settings.
Co-Authors Agusta, Laksmi Senja Anakotta, Vircha Arief Cahyadi Auerkari, Aino Nindya Bambang Suryono, Bambang Claudia, Tasya Cresma, Avisa Cetta Devani, Krissa Devina, Yoan Dewi Yulianti Bisri Diana C. Lalenoh, Diana C. Dita Aditianingsih Fadhila, Fulki Gunanta, Yohanes Hafidz, Noor Hansen Angkasa Helmy Fitriawan herpratiwi Herpratiwi Herpratiw Kartika, Gloria Kurniawan, Teddy Lantang, Anastasia Magdalena Manggala, Sidharta Kusuma Mujono, Aivi Natanegara, Ahmad Pasha Omega, Andy Parasian, Luther Holan Permana, Affan Priyambodo Putu Pramana Suarjaya Ramlan, Andi Ade Wijaya Rangga Firdaus Reza, Harris Putra Saleh, Siti Chasnak Setiani, Dea Britta Hilda Sri Rahardjo Sugianto, Astrid Indrafebrina Sugiarto, Adhrie Sukoco, Gunawan Sutaniyasa, I Gede Sutedja, Anasthasia D. Talitaputri, Clarissa Emiko Tantri, Aida Rosita Tantri, Ignatia Novianti Tatang Bisri Theresia, Sandy Wicaksana, Daffa Abhista Yunda, Girhanif Amri Yustisia, Fitria Isnarsandhi