The effect of a rapid response team on major clinical outcome measures in a community hospital*

Dacey, Michael J.; Mirza, Ehsun Raza; Wilcox, Virginia; Doherty, Maureen; Mello, James; Boyer, Amy; Gates, Jonathan D.; Baute, Robert

doi:10.1097/01.ccm.0000281518.17482.ee

Cited by 160 publications

(118 citation statements)

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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%

“…This retrospective study cannot prove a cause-effect relationship; a prospective randomized trial would be required to answer the question definitively. Based on the available data suggesting some benefit in restorative outcomes [2][3][4][5][6][7][8] and pressure from federal regulators to deploy RRTs regardless, 1 a retrospective cohort design may provide the only realistic means of addressing this question.…”

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%

Section: Discussionmentioning

confidence: 99%

mentioning

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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“…ERT intervention may reduce ICU resource utilization 9 and immediate mortality after cardiac arrest. 3,6,[10][11][12][13] However, a large meta-analysis did not find evidence that these initiatives reduce the overall in-hospital mortality. 14 In contrast, introduction of ERTs was found to increase long-term survival in surgical patients.…”

Section: Figure Cumulative Frequency Of Time To Emergency Response Tmentioning

confidence: 99%

“…Because ERT systems are costly, 3 some authors have proposed preemptive triage of higher-acuity patients to intensive care units (ICUs) or progressive care units (eg, step-down units). 4 The problem with such an approach is that sudden postoperative adverse events can occur even in patients whose condition was stable in the postanesthesia recovery unit (PACU) and who fulfilled discharge criteria for dismissal to regular wards.…”

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confidence: 99%

Postoperative Emergency Response Team Activation at a Large Tertiary Medical Center

Weingarten

Venus

Whalen

et al. 2012

Mayo Clinic Proceedings

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Objective: To study characteristics and outcomes associated with emergency response team (ERT) activation in postsurgical patients discharged to regular wards after anesthesia. Patients and Methods:We identified all ERT activations that occurred within 48 hours after surgery from June 1, 2008, through December 31, 2009, in patients discharged from the postanesthesia care unit to regular wards. For each ERT case, up to 2 controls matched for age (Ϯ10 years), sex, and type of procedure were identified. A chart review was performed to identify factors that may be associated with ERT activation. Results: We identified 181 postoperative ERT calls, 113 (62%) of which occurred within 12 hours of discharge from the postanesthesia care unit, for an incidence of 2 per 1000 anesthetic administrations (0.2%). Multiple logistic regression analysis revealed the following factors to be associated with increased odds for postoperative ERT activation: preoperative central nervous system comorbidity (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.20-5.32; Pϭ.01), preoperative opioid use (OR, 2.00; 95% CI, 1.30-3.10; Pϭ.002), intraoperative use of phenylephrine infusion (OR, 3.05; 95% CI, 1.08-8.66; Pϭ.04), and increased intraoperative fluid administration (per 500-mL increase, OR, 1.06; 95% CI, 1.01-1.12; Pϭ.03). ERT patients had longer hospital stays, higher complication rates, and increased 30-day mortality compared with controls. Conclusion: Preoperative opioid use, history of central neurologic disease, and intraoperative hemodynamic instability are associated with postoperative decompensation requiring ERT intervention. Patients with these clinical characteristics may benefit from discharge to progressive or intensive care units in the early postoperative period.

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Rapid Response Teams

Chan

Jain

Nallmothu³

et al. 2010

Arch Intern Med

668

179

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The effect of a rapid response team on major clinical outcome measures in a community hospital*

Abstract: The deployment of an RRT led by physician assistants with specialized skills was associated with significant decreases in rates of in-hospital cardiac arrest and unplanned intensive care unit admissions.

Cited by 160 publications

References 12 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

Postoperative Emergency Response Team Activation at a Large Tertiary Medical Center

Rapid Response Teams

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