THE EFFECT OF TRANSITION FROM A TRADITIONAL CODE TEAM TO A RAPID RESPONSE TEAM IN A CHILDRENʼs CENTER: A BEFORE AND AFTER INTERVENTION TRIAL.

Hunt, Elizabeth A.; Shilkofski, Nicole; Rinke, Michael L.; Zimmer, Karen P.; Matlin, Carol; Garger, Catherine; Miller, Marlene R.

doi:10.1097/00003246-200512002-00066

Cited by 2 publications

(6 citation statements)

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“…We sought to examine the effects of all RRS subtypes and using quantitative analysis and analysis of methodological quality, to determine the overall effect of RRSs. The results of our analysis (which included data from several newer studies 31,38,39 ) support and extend the conclusion of prior reviews that RRSs, although a potentially promising intervention, do not unequivocally benefit patients and are not worthy of more widespread use until more evidence becomes available. Our analysis also demonstrates that many studies widely cited as supporting wide implementation of RRSs are flawed and probably not generalizable.…”

Section: Systematic Review Of Rapid Response Systems / Ranji Et Al 429supporting

confidence: 81%

“…All were conducted in academic teaching hospitals. Two studies 37,38 focused on pediatric inpatients, and the remainder involved hospitalized adults. The RRS intervened for all hospitalized patients in all but 2 studies (1 of which focused on surgical inpatients 33 and the other in which the RRS Elements affecting study internal validity and translatability.…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

“…Seven studies [22][23][24]34,[36][37][38] reported enough information to calculate the RRS calling rate (4 studies 24,31,39,40 reported the total number of calls but not the number of admissions, and 2 studies 3,35 did not report either). In these 7 studies, the calling rate varied from 4.5 to 25.8 calls per 1000 admissions.…”

Section: Rrs Usage and Effects On Patient Outcomesmentioning

confidence: 99%

“…In these 7 studies, the calling rate varied from 4.5 to 25.8 calls per 1000 admissions. Three studies documented the calling rate before and after the intervention: a study at a hospital with a preexisting RRS 34 reported that the calling rate increased from 13.7 to 25.8 calls per 1000 admissions after an intensive education and publicity program; in a pediatric trial, 38 the overall emergency calling rate (for cardiac arrests and medical emergencies) was reported to increase from 6.6 to 10.4 per 1000 admissions; and in the MERIT trial, 36 calls increased from 3.1 to 8.7 per 1000 admissions.…”

Section: Rrs Usage and Effects On Patient Outcomesmentioning

confidence: 99%

“…Nine studies 3,22,23,33,[35][36][37]39,40 reported the effect of an RRS on inpatient mortality, 9 studies 22,23,31,33,34,[36][37][38]40 reported its effect on cardiopulmonary arrests, and 6 studies 3,22,24,33,36,37 reported its effect on unscheduled ICU admissions. Of these, 7 trials that reported mortality and cardiopulmonary arrests and 6 studies that reported unscheduled ICU admissions supplied sufficient data for meta-analysis.…”

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

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Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

100

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BACKGROUNDA rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster‐randomized trial.PURPOSETo evaluate the effects of RRSs on clinical outcomes through a systematic literature review.DATA SOURCESMEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies.STUDY SELECTIONRandomized and nonrandomized controlled trials, interrupted time series, and before‐after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions.DATA EXTRACTIONTwo authors independently determined study eligibility, abstracted data, and classified study quality.DATA SYNTHESISThirteen studies met inclusion criteria: 1 cluster‐randomized controlled trial (RCT), 1 interrupted time series, and 11 before‐after studies. The RCT showed no effects on any clinical outcome. Before‐after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74‐0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65‐0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before‐after studies.CONCLUSIONSPublished studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before‐after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422–432. © 2007 Society of Hospital Medicine.

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Section: Systematic Review Of Rapid Response Systems / Ranji Et Al 429supporting

confidence: 81%

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

Section: Rrs Usage and Effects On Patient Outcomesmentioning

confidence: 99%

Section: Rrs Usage and Effects On Patient Outcomesmentioning

confidence: 99%

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

100

View full text Add to dashboard Cite

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The effect of medical emergency teams on patient outcome: A review of the literature

Laurens

Dwyer

2010

Int J of Nursing Practice

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This paper presents a review of literature on the impact of the medical emergency team (MET) on inpatient mortality, cardiopulmonary arrests or unscheduled intensive care unit (ICU) admissions. A total of 14,172 abstracts and 98 full text papers were reviewed. In total, 24 met the inclusion criteria, 2 used a cluster-randomized controlled trial, 11 before and after, 6 retrospective analyses, 4 prospective cohorts and 1 not reported. There is moderate to strong evidence that METs are associated with decreased mortality and cardiac arrest rates, and weak evidence on its impact on ICU admission rate reductions. This evidence suffers from the flaws with only two randomized controlled trials examining differing outcome measures with differing results. Poor methodology and failure to report both quality improvement co-interventions and time response rates of METs, limit the strength of the evidence that METs are effective interventions for preventing mortality, code rates or unscheduled ICU admissions. Studies with improved implementation practices and evaluation of the efficacy of MET is warranted.

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THE EFFECT OF TRANSITION FROM A TRADITIONAL CODE TEAM TO A RAPID RESPONSE TEAM IN A CHILDRENʼs CENTER: A BEFORE AND AFTER INTERVENTION TRIAL.

Cited by 2 publications

References 0 publications

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

The effect of medical emergency teams on patient outcome: A review of the literature

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