Reduction in hospital-wide mortality following implementation of a rapid response team: a long-term cohort study.
Crit Care. 2011 Nov 15;15(6):R269
Authors: Beitler JR, Link N, Bails DB, Hurdle K, Chong DH
Abstract
ABSTRACT: INTRODUCTION: Rapid response teams (RRTs) have been shown to reduce cardiopulmonary arrests outside the intensive care unit (ICU). Yet the utility of RRTs remains in question, as most large studies have failed to demonstrate a significant reduction in hospital-wide mortality following RRT implementation. METHODS: A cohort design with historical controls was used to determine the effect on hospital-wide mortality of an RRT in which clinical judgment, in addition to vital signs criteria, was widely promoted as a key trigger for activation. All non-prisoner patients admitted to a tertiary referral public teaching hospital from 2003 through 2008 were included. A total of 77,021 admissions preintervention (2003 through 2005) and 79,013 admissions postintervention (2006 through 2008) were evaluated. The a priori primary outcome was unadjusted hospital-wide mortality. A Poisson regression model was then used to adjust for hospital-wide mortality trends over time. Secondary outcomes defined a priori were unadjusted out-of-ICU mortality and out-of-ICU cardiopulmonary arrest codes. RESULTS: A total of 855 inpatient RRTs (10.8 per 1,000 hospital-wide discharges) were activated during the three-year postintervention period. Forty-seven percent of RRTs were activated for reasons of clinical judgment. Hospital-wide mortality decreased from 15.50 to 13.74 deaths per 1,000 discharges following RRT implementation (relative risk 0.887, 95% CI 0.817-0.963; p=0.004). After adjusting for inpatient mortality trends over time, the reduction in hospital-wide mortality remained statistically significant (relative risk 0.825, 95% CI 0.694-0.981; p=0.029). Out-of-ICU mortality decreased from 7.08 to 4.61 deaths per 1,000 discharges (relative risk 0.651, 95% CI 0.570-0.743; p<0.001). Out-of-ICU cardiopulmonary arrest codes decreased from 3.28 to 1.62 codes per 1,000 discharges (relative risk 0.493, 95% CI 0.399-0.610; p<0.001). CONCLUSIONS: Implementation of an RRT in which clinical judgment, in addition to vital signs criteria, was widely cited as a rationale for activation was associated with a significant reduction in hospital-wide mortality, out-of-ICU mortality, and out-of-ICU cardiopulmonary arrest codes. The frequent use of clinical judgment as a criterion for RRT activation was associated with high RRT utilization.
PMID: 22085785 [PubMed - as supplied by publisher]