Effect of a Rapid Response Team on Hospital-wide Mortality and Code Rates Outside the ICU in a Children’s Hospital

Sharek, Paul J.; Parast, Layla; Leong, Kit; Coombs, J. H. B.; Earnest, Karla; Sullivan, Jill; Frankel, Lorry R.; Roth, Stephen J.

doi:10.1001/jama.298.19.2267

Cited by 326 publications

(240 citation statements)

References 42 publications

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“…First, the sample size was relatively small compared to other published studies, [2][3][4][5][6][7][8][9][10][11] promoting the possibility that either epoch was not representative of pre-RRT and post-RRT parent populations. Another weakness is that QOD was measured using surrogate endpoints.…”

Section: Discussionmentioning

confidence: 99%

“…1 Clinical studies that have focused on whether RRTs improve restorative care outcomes, frequency of cardiac arrest, and critical care utilization have yielded mixed results. [2][3][4][5][6][7][8][9][10][11] One study suggested that RRTs might provide an opportunity to enhance palliative care of hospitalized patients. 11 In this study, RRT personnel ''felt that prior do-not-resuscitate orders would have been appropriate'' in nearly a quarter of cases.…”

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confidence: 99%

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Enhanced end‐of‐life care associated with deploying a rapid response team: A pilot study

Vázquez

Gheorghe

Grigoriyan

et al. 2009

Journal of Hospital Medicine

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The authors have no financial or intellectual conflicts of interest relevant to this research. The research was not supported by external funding.HYPOTHESIS: Institution of a rapid response team (RRT) improves patients' quality of death (QOD). SETTING: A 425-bed community teaching hospital. PATIENTS: All medical-surgical patients whose end-of-life care was initiated on the hospital wards during the 8 months before (pre-RRT) and after (post-RRT) actuation.STUDY DESIGN: Retrospective cohort study. METHODS: Medical records of all patients were reviewed using a uniform data abstraction tool. Demographic information, diagnoses, physiologic and laboratory data, and outcomes were recorded. RESULTS:A total of 197 patients died in both the pre-RRT and post-RRT periods. There were no differences in age, sex, advance directives, ethnicity, or religion between groups. Restorative outcomes, including in-hospital mortality (27 vs. 30/ 1000 admissions), unexpected transfers to intensive care (17 vs. 19/1000 admissions) and cardiac arrests (3 vs. 2.5/1000 admissions) were similar during the 2 periods. Outcomes, including formal comfort care only orders (68 vs. 46%), administration of opioids (68 vs. 43%), pain scores (3.0 AE 3.5 vs. 3.7 AE 3.2), patient distress (26 vs. 62%), and chaplain visits (72 vs. 60%), were significantly better in the post-RRT period compared to the pre-RRT period (all P < 0.05). During the post-RRT period, 61 patients died with RRT care and 136 died without RRT care. End-of-life care outcomes were similar for these groups except more RRT patients had chaplain visits proximate to their deaths (80% vs. 68%; P ¼ 0.0001). CONCLUSIONS:Institution of an RRT in our hospital had negligible impact on outcomes of patients whose goal was restorative care. Deployment of the RRT was associated with generally improved end-of-life pain management and psychosocial care.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Enhanced end‐of‐life care associated with deploying a rapid response team: A pilot study

Vázquez

Gheorghe

Grigoriyan

et al. 2009

Journal of Hospital Medicine

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“…In the inpatient setting, rapid response teams (RRTs) or medical emergency teams (METs) have become increasingly common as a mechanism to respond to acute changes in patient clinical stability with variable improvement in patient outcome. [8][9][10][11] These dedicated multidisciplinary teams are typically composed of providers who are not part of the primary team caring for the patient. A clinical triggers program based on abnormal vital signs was introduced at Denver Health Medical Center as a variation of the RRT program that utilized the primary team caring for the patient as the principal respondents to patients with deteriorating conditions.…”

Section: Introductionmentioning

confidence: 99%

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Imperato

Mehegan

Henning³

et al. 2016

CJEM

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Background: Because abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs. Objectives: To determine if a clinical triggers program in the emergency department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician-led multidisciplinary team had a measurable effect on inpatient hospital metrics. Methods: The study design was a retrospective pre and post intervention study. The intervention was the implementation of an ED clinical "triggers" program. Abnormal vital sign criteria that warranted a trigger response included: heart rate <40 beats/minute or >130 beats/minutes, respiratory rate <8 breaths/minute or >30 breaths/minute, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was the median days admitted with secondary outcomes of median days in special care unit, in-hospital 30-day mortality and proportion of patients who required an upgrade in inpatient care level. Results: There was no difference in median days admitted for inpatient care (3.8 v. 4.0 days, p = 0.21) or median days spent in a special care unit (5.0 v. 5.6 days, p = 0.42) between the groups. There was no difference in the percentage of in-hospital patient deaths (6.0% v. 5.6%, p = 0.66) or frequency of upgrade in level of care within 24 hours (4.9% v. 4.0%, p = 0.52). Conclusions: In our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.

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“…Rapid response teams can play a critical role in reducing mortality and code rates [12]. Yet research on improving response times of neonatal rapid response teams is limited.…”

Section: Discussionmentioning

confidence: 99%

Potential Structural Obstacles to Effective Implementation of Neonatal Intensive Care Unit Rapid Response Teams

P¹,

Pham²,

Fletcher³

et al. 2017

Clinics Mother Child Health

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Background: In-hospital rapid response teams are critical to the prompt management of neonatal emergencies occurring in hospital delivery rooms. However, structural obstacles that exist within health care facilities may hinder the successful implementation of these teams. This study examined the prevalence of structural obstacles potentially impeding neonatal rapid response team movements between neonatal intensive care units and delivery rooms in hospitals with pediatric residency programs across the United States.

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Effect of a Rapid Response Team on Hospital-wide Mortality and Code Rates Outside the ICU in a Children’s Hospital

Cited by 326 publications

References 42 publications

Enhanced end‐of‐life care associated with deploying a rapid response team: A pilot study

Enhanced end‐of‐life care associated with deploying a rapid response team: A pilot study

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Potential Structural Obstacles to Effective Implementation of Neonatal Intensive Care Unit Rapid Response Teams

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