A novel configuration of a traditional rapid response team decreases non–intensive care unit arrests and overall hospital mortality

Abstract

BACKGROUND In‐hospital cardiopulmonary arrest (CPA) accounts for substantial morbidity and mortality. Rapid response teams (RRTs) are designed to prevent non–intensive care unit (ICU) CPA through early detection and intervention. However, existing evidence has not consistently demonstrated a clear benefit. OBJECTIVE To explore the effectiveness of a novel RRT program design to decrease non‐ICU CPA and overall hospital mortality. METHODS This study was conducted from the start of fiscal year 2005 to 2011. In November 2007, our hospitals implemented RRTs as part of a novel resuscitation program. Charge nurses from each inpatient unit underwent training as unit‐specific RRT members. Additionally, all inpatient staff received annual training in RRT concepts including surveillance and recognition of deterioration. We compared the incidence of ICU and non‐ICU CPA from first complete preimplementation year 2006 to postimplementation years 2007 to 2011. Overall hospital mortality was also reported. RESULTS The incidence of non‐ICU CPA decreased, whereas the incidence of ICU CPA remained unchanged. Overall hospital mortality also decreased (2.12% to 1.74%, P < 0.001). The year‐over‐year change in RRT activations was inversely related to the change in Code Blue activations for each inpatient unit (r = −0.68, P < 0.001). CONCLUSION Our novel RRT program was associated with a decreased incidence of non‐ICU CPA and improved hospital mortality. Journal of Hospital Medicine 2015;10:352–357. © 2015 Society of Hospital Medicine

Rapid response team: what factors interfere with its performance

“…(13)(14)(15)(16)(17) The teams were mostly composed of doctors, nurses, and physical therapists with experience and/ or specialization in critical care. (13)(14)(15)(16)(17)(18)(19)(20) Some studies included a pharmacist, laboratory technicians, radiology technicians, and administrators and clinical secretaries. (13,(16)(17)(18)20) It was shown that the presence of a resident doctor in the team represented no difference when compared with the responsible intensivist.…”

In reference to “A novel configuration of a traditional rapid response team decreases non–intensive care unit arrests and overall hospital mortality”

“…Davis et al's novel RRT program showed improvement in non-ICU CPAs and in-hospital mortality. 1 The researchers and their institutions did a great job in improving outcomes, perhaps by devoting enough resources and creating a positive work environment for the nursing staff.A large observational study conducted in 9 European countries showed that an increase in a nurses' workload by 1 patient increased the likelihood of a hospitalized patient dying within 30 days of admission by 7%. Furthermore, every 10% increase in nurses with a bachelor's degree was associated with a decrease in this likelihood by 7%.…”

“…Davis et al's novel RRT program showed improvement in non-ICU CPAs and in-hospital mortality. 1 The researchers and their institutions did a great job in improving outcomes, perhaps by devoting enough resources and creating a positive work environment for the nursing staff.…”

“…4 Therefore, there are many factors that could have had an impact on in-hospital mortality in this study. 1 It will be interesting to know if there was a difference in the novel RRT's success rates in the primary medical center and smaller sister campus in the study by Davis et al 1 Activation of RRTs based on the change in vital signs is challenging for the elderly. 5 Therefore, geriatrics-unit staff need special training for RRTs to be successful.…”

“…1 Additionally, the charge nurse responded to each RRT code and received intensive training. This strategy may have contributed to the benefit shown by the novel RRT strategy.…”