Abstract 11781: Association of Rapid Response Teams With Hospital Mortality in Medicare Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Saket Girotra ◽  
Philip Jones ◽  
Mary A Peberdy ◽  
Mary S Vaughan Sarrazin ◽  
Paul S Chan
Keyword(s):  
Hospital Mortality ◽  
Median Duration ◽  
Interrupted Time Series ◽  
Rapid Response ◽  
Annual Number ◽  
Rapid Response Teams ◽  
Implementation Period ◽  
Using Data ◽  
Expected Mortality ◽  
Get With The Guidelines

Background: Rapid response teams (RRT) have been promoted as a strategy to reduce unexpected hospital deaths, as they are designed to evaluate and treat patients experiencing sudden decline. However, evidence to support their effectiveness in reducing in-hospital mortality remains uncertain. Methods: Using data from 56 hospitals participating in Get With The Guidelines Resuscitation linked to Medicare, we calculated annual rates of case-mix adjusted mortality for each hospital during 2000-2014. We constructed a hierarchical interrupted time series model to determine whether implementation of a RRT was associated with a reduction in mortality that was larger than expected based on pre-implementation trends alone. Results: Over the study period, the median annual number of Medicare admissions across study hospitals was 5214 (range: 408-18,398). The median duration of the pre-implementation period was 7.6 years comprising ~2.5 million admissions, and the median duration of the post-implementation period was 7.2 years comprising ~2.6 million admissions. Before implementation of RRTs, hospital mortality was already decreasing by 2.7% annually (Figure). Implementation of RRTs was not associated with change in mortality in the initial year of implementation (RR for model intercept: 0.98; 95% CI 0.94-1.02; P= 0.30) or in the mortality trend over time (RR for model slope: 1.01 per-year; 95% CI 0.99-1.02; P =0.30). Within individual hospitals, a RRT was associated with a significantly lower than expected mortality at 4 (7.1%) of hospitals, and significantly higher than expected mortality at 2 (3.6%), when compared to pre-implementation trends. Conclusion: Among a diverse sample of U.S. hospitals, we found that the implementation of a RRT was not associated with a significant reduction in hospital mortality. Given their prevalence in most U.S. hospitals, further studies are needed to understand best practices in composition, design, and implementation of RRTs.

scholarly journals Reduced frequency of cardiopulmonary arrests by rapid response teams

2012 ◽  
Vol 10 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Paulo David Scatena Gonçales ◽  
Joyce Assis Polessi ◽  
Lital Moro Bass ◽  
Gisele de Paula Dias Santos ◽  
Paula Kiyomi Onaga Yokota ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response Team ◽  
Rapid Response ◽  
High Complexity ◽  
Rapid Response Teams ◽  
Cardiorespiratory Arrest ◽  
Reduced Frequency ◽  
Before And After ◽  
Response Team ◽  
The Impact

OBJECTIVE: To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS: A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS: During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p<0.001) and 14.34 deaths/1,000 discharges (p=0.029). CONCLUSION: The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

scholarly journals In-hospital Emergencies Versus Out-of-hospital Emergencies Admitted to ICU: Is the Outcome Different? An Observational Study

2020 ◽  
Author(s):  
Emi Cauchois ◽  
Jérémy Bourenne ◽  
Audrey Le Saux ◽  
Fouad Bouzana ◽  
Antoine Tilmont ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response ◽  
University Hospital ◽  
Admission Diagnosis ◽  
Medical Systems ◽  
Rapid Response Teams ◽  
Mechanical Ventilation Support ◽  
Organ Failures ◽  
Response Systems ◽  
Emergency Medical Systems

Abstract Background: Rapid Response Systems (RRS) are now commonly implemented throughout hospital health systems to manage in-hospital emergencies (IHE). There is limited data on characteristics and outcomes of such patients admitted to an intensive care unit (ICU). The goal was to determine whether the hospital mortality of ICU patients was different depending on their admission pathway: in-hospital via rapid response teams (RRT), or out-of-hospital emergencies (OHE) via prehospital emergency medical systems. Results: Out of 422 ICU admissions (Timone University Hospital ICU), 241 patients were retrospectively (2019-2020) included: 74 IHE versus 167 OHE. In-hospital mortality rates did not differ between both cohorts (n = 31(42%) vs. 63(39%) respectively, NS). IHE patients were older and had more comorbidities (immunosuppression and ongoing malignancy). OHE patients had more severe organ failures at presentation with more frequent mechanical ventilation support. Independent global hospital mortality risk factors were ongoing malignancy (OR = 10.4 [2.7-40], p < 0.001), SAPS II (OR = 1.05 [1.03-1.08], p < 0.0001) and SOFA scores (OR = 1.14 [1.01-1.3], p < 0.05), hemorrhagic stroke as admission diagnosis (OR = 8.4 [2.7-26], p < 0.001), and arterial lactate on arrival (OR = 1.11 [1.03-1.2], p < 0.01). Conclusion: This study provides a thorough and comprehensive analysis of characteristics and outcomes of ICU admissions following a mature rapid response activation system, compared to the “conventional” out-of-hospital admission pathway. Despite the more vulnerable background of IHE patients, hospital mortality does not differ, supporting the use of early RRS to identify deteriorating ward patients.

Abstract 319: A Multi-faceted Programmatic Approach Associated with Over 50% Reduction in In-hospital Mortality

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Amrita Mukhopadhyay ◽  
Wai Sha (Sally) Cheung ◽  
Eugene Yuriditsky ◽  
Karsten Drus ◽  
Quyen Wong ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Care Facility ◽  
Interrupted Time Series ◽  
The United States ◽  
Outpatient Setting ◽  
Evidence Based ◽  
Rapid Response Teams ◽  
Affiliate Hospital ◽  
Main Hospital ◽  
Hospital Patients

Introduction: In the United States, the chance of dying in the hospital widely varies by hospital, with bottom-decile hospitals having twice the rates of risk-adjusted mortality when compared to top-decile hospitals. This suggests a need for improvement in health systems nationwide. Here, we describe the implementation of, and associated outcomes for a multi-faceted, evidence-based approach to reducing in-hospital mortality. Methods: This is a retrospective interrupted time-series conducted at a large, urban, academic health system. Specifically, we describe the implementation of the following evidence-based methods: 1) escalation of communication guidelines, 2) proactive rounding with nurse response teams, and 3) rapid response teams with dedicated staff. We then quantify the associated observed-to-expected (O:E) in-hospital mortality over a 12-year period at our main hospital, and subsequently over a 3-year period at an affiliated hospital where the same interventions were later implemented. Results: Over 12 years, 445,308 patients were discharged from our main hospital, with 3,948 (0.9%) being discharged to an acute care facility, 4,558 (1.0%) discharged to hospice, and 4,648 (1.0%) expiring in the hospital. Patients had an average age of 53.1 years (std.dev 22.8 years), with the majority being female (59.0%), non-Hispanic white (66.1%), and admitted from the outpatient setting (93.3%). From the years 2010 to 2013, there was decline in O:E mortality by 59.0% (Figure 1A). This effect was sustained from 2014-2018. At the affiliate hospital, there was a similar decline in O:E mortality after implementation of the same interventions (60.5%, Figure 1B). Conclusion: Our multi-faceted, programmatic approach was associated with over 50% reductions in in-hospital mortality that were sustained for several years after implementation, and were reproduced at an affiliated hospital.

scholarly journals A study of community mortality at the weekend versus during the week. Is there a correlation with in-hospital mortality?

2019 ◽  
Vol 24 (4) ◽  
pp. 229-234
Author(s):  
Oliver Beaumont ◽  
Matthew Willett ◽  
Susan Dutton ◽  
Karen Vadher
Keyword(s):  
Hospital Mortality ◽  
Weekend Effect ◽  
Annual Number ◽  
Age Group ◽  
Expected Number ◽  
National Statistics ◽  
Significant Difference ◽  
Day Of The Week ◽  
The Mean ◽  
Using Data

Objective A so-called ‘weekend effect’ has been described in which mortality among those admitted to hospital at a weekend is higher than among those admitted on weekdays. The causes for the weekend effect remain unclear. This study examined patterns of community mortality to explore whether a shift from the community to hospital may account for observed differences in hospital mortality rates across the week. Methods The annual number of deaths in the community was compared to that in hospitals in England and Wales during 2012 to 2014 using data from the Office for National Statistics. Analyses included the mean annual deaths, by age group and by cause of death in the community and hospital and comparison of the proportion of deaths on each day of the week to the expected number of deaths. Results The observed and expected total number of deaths in the community were broadly similar on the weekend and weekday ( P = 0.386). There was no difference between observed and expected rates when comparing average daily weekday deaths to the average daily weekend deaths in the community ( P = 0.434). In addition, there was no difference in the proportion of deaths in the community on the weekend when compared to the expected rate for those aged under 65, 75–84 and 85+ years. People were more likely to die on the weekend (rather than the weekday) in the community from neoplasms ( P = 0.009) but less likely to die from cardiovascular disease ( P = 0.012) or those aged 65–74 years. Conclusion We found no evidence of a significant difference in the risk of dying in the community at the weekend compared to during the week, or between the observed and expected deaths on each day. The lower risk of dying in the community at the weekend from cardiovascular diseases and among those aged 65–74 years and the higher risk for neoplasms are of interest but marginal. We found no evidence of a shift in deaths from the community to hospital at weekends.

Data Fail to Back Rapid Response Teams

2011 ◽  
Vol 4 (6) ◽  
pp. 8-9
Author(s):  
MARY ANN MOON
Keyword(s):  
Rapid Response ◽  
Rapid Response Teams

scholarly journals Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study

2021 ◽  
Vol 18 (11) ◽  
pp. 6136
Author(s):  
Jeonggyo Yoon ◽  
Minsun Kang ◽  
Jaehun Jung ◽  
Min Jae Ju ◽  
Sung Hwan Jeong ◽  
...  
Keyword(s):  
Health Insurance ◽  
Lung Injury ◽  
National Health Insurance ◽  
Population Based ◽  
Annual Number ◽  
Population Based Study ◽  
Annual Consumption ◽  
Using Data ◽  
Water Tanks ◽  
Biocidal Product

Humidifier disinfectant (HD) is a household biocidal product used in humidifier water tanks to prevent the growth of microorganisms. In 2011, a series of lung injury cases of unknown causes emerged in children and pregnant women who had used HD in Korea. This study investigated changes in the nationwide number of cases of humidifier disinfectant-associated lung injury (HDLI) in concordance with nationwide HD consumption using data covering the entire Korean population. More than 25 kinds of HD products were sold between 1994 and 2011. The number of diagnosed HDLI, assessed by S27.3 (other injuries of lungs) of the Korea National Health Insurance Service (NHIS) data, sharply increased by 2005, subsequently decreased after 2005, and almost disappeared after 2011 in concordance with the annual number of HD sales. The number of self-reported HDLIs, assessed using data from all suspected HDLI cases registered in the Korea Ministry of Environment, changed with the annual number of HD sales, with a delay pattern, potentially induced by the late awareness of lung injury diseases. The present study suggests that changes in the nationwide annual consumption of HD products were consistent with changes in the annual number of HDLI cases in Korea.

scholarly journals The Simulation-Based Assessment of Pediatric Rapid Response Teams

2017 ◽  
Vol 188 ◽  
pp. 258-262.e1 ◽  
Author(s):  
James J. Fehr ◽  
Mary E. McBride ◽  
John R. Boulet ◽  
David J. Murray
Keyword(s):  
Rapid Response ◽  
Rapid Response Teams ◽  
Simulation Based

scholarly journals Historical variation and trends in storminess along the Portuguese South Coast

2011 ◽  
Vol 11 (9) ◽  
pp. 2407-2417 ◽  
Author(s):  
L. P. Almeida ◽  
Ó. Ferreira ◽  
M. I. Vousdoukas ◽  
G. Dodet
Keyword(s):  
Wave Height ◽  
Linear Increase ◽  
Annual Number ◽  
The North ◽  
Storm Wave ◽  
Using Data ◽  
The North Atlantic Oscillation ◽  
Historical Variation ◽  
Storm Characteristics ◽  
South Portugal

Abstract. This work investigates historical variation and trends in storm climate for the South Portugal region, using data from wave buoy measurements and from modelling, for the period 1952 to 2009. Several storm parameters (annual number of storms; annual number of days with storms; annual maximum and mean individual storm duration and annual 99.8th percentile of significant wave height) were used to analyse: (1) historical storminess trends; (2) storm parameter variability and relationships; and (3) historical storminess and its relationship to the North Atlantic Oscillation (NAO). No statistically significant linear increase or decrease was found in any of the storm parameters over the period of interest. The main pattern of storm characteristics and extreme wave heights is an oscillatory variability with intensity peaks every 7–8 yr, and the magnitude of recent variations is comparable with that of variations observed in the earlier parts of the record. In addition, the results reveal that the NAO index is able to explain only a small percentage of the variation in storm wave height, suggesting that more local factors may be of importance in controlling storminess in this region.

Rapid Response Teams: Qualitative Analysis of Their Effectiveness

2013 ◽  
Vol 22 (3) ◽  
pp. 198-210 ◽  
Author(s):  
Linda Searle Leach ◽  
Ann M. Mayo
Keyword(s):  
Time Pressure ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Multiple Perspectives ◽  
Rapid Response Teams ◽  
Effective Response ◽  
Team Members ◽  
Grounded Theory Method ◽  
Response Team ◽  
Patients At Risk

Background Multidisciplinary rapid response teams focus on patients’ emergent needs and manage critical situations to prevent avoidable deaths. Although research has focused primarily on outcomes, studies of the actual team effectiveness within the teams from multiple perspectives have been limited. Objective To describe effectiveness of rapid response teams in a large teaching hospital in California that had been using such teams for 5 years. Methods The grounded-theory method was used to discover if substantive theory might emerge from interview and/or observational data. Purposeful sampling was used to conduct in-person semistructured interviews with 17 key informants. Convenience sampling was used for the 9 observed events that involved a rapid response team. Analysis involved use of a concept or indicator model to generate empirical results from the data. Data were coded, compared, and contrasted, and, when appropriate, relationships between concepts were formed. Results Dimensions of effective team performance included the concepts of organizational culture, team structure, expertise, communication, and teamwork. Conclusions Professionals involved reported that rapid response teams functioned well in managing patients at risk or in crisis; however, unique challenges were identified. Teams were loosely coupled because of the inconsistency of team members from day to day. Team members had little opportunity to develop relationships or team skills. The need for team training may be greater than that among teams that work together regularly under less time pressure to perform. Communication between team members and managing a crisis were critical aspects of an effective response team.

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