Effect of a rapid response system on code rates and in-hospital mortality in medical wards

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P<0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

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Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study

International Journal of Emergency Medicine ◽

10.1186/s12245-019-0248-5 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Awad Al-Omari ◽

Abbas Al Mutair ◽

Fadi Aljamaan

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Cardiopulmonary Arrest ◽

Rapid Response Team ◽

Rapid Response ◽

Dramatic Reduction ◽

Rapid Response System ◽

Private Hospitals ◽

Response System ◽

Response Team

Abstract Background Cardiopulmonary arrest may result in high mortality rate in hospitals where the rapid response team is not implemented. A rapid response system can recognize patients at high risk of cardiopulmonary arrest and provide the needed medical management to prevent further deterioration. The rapid response system has shown a dramatic reduction in mortality rate and cardiopulmonary arrest. Objective To evaluate the effectiveness of the rapid response team (RRT) implementation in reducing the mortality rate, number of cardiopulmonary arrests, and number of ICU admission. Design A pre- and post-rapid response team system implementation. Setting Four tertiary private hospitals in Saudi Arabia. Patients A total of 154,869 patients in the 3-year before rapid response system period (January 2010 to December 2012) and a total of 466,161 during the 2.5-year post-RRT implementation period (January 2014 to June 2016). Results Results indicated that ward nurses activated RRT more often than physicians (1104 activations [69%] vs. 499 activations [31%]), with cardiovascular and respiratory abnormalities being the most common triggers. Serious concern about the patient condition by the ward staff was the trigger for 181 (11.29%) activations. The RRT provided a variety of diagnostic and therapeutic interventions. Most patients cared for by RRT were admitted to ICU 1103 (68.81%), and the rest 500 (31.19%) were managed in the ward. After the implementation of the RRT project, the hospital mortality rate dropped from 7.8 to 2.8 per 1000 hospital admission. Hospital cardiopulmonary arrest rate has dropped from 10.53 per 1000 hospital admissions to 2.58. Rapid response team implementation also facilitated end-of-life care discussions. Conclusion Implementation of the RRT project has shown a dramatic reduction in the total ICU admissions, average ICU occupancy rate, total hospital mortality, and total ICU mortality. These findings reinforce the evidence that RRT implementation is effective in reducing hospital mortality and cardiopulmonary arrest rates in addition to other outcomes related to healthcare quality.

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MIER project “Hospital mortality and containment strategy” – in-hospital rapid response system (RRS) implementation multicenter prospective study in Emilia-Romagna (ER)

Resuscitation ◽

10.1016/j.resuscitation.2010.09.183 ◽

2010 ◽

Vol 81 (2) ◽

pp. S43

Author(s):

E.L. Cerchiari ◽

F. Semeraro ◽

G. Gambale ◽

M. Terzitta ◽

A. Vezzani ◽

...

Keyword(s):

Hospital Mortality ◽

Prospective Study ◽

Rapid Response ◽

Rapid Response System ◽

Response System ◽

Containment Strategy ◽

Multicenter Prospective Study

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Predictors of in-hospital Mortality After Rapid Response System Activation in a Newly Established Tertiary Hospital

Turkish Journal of Intensive Care ◽

10.4274/tybd.galenos.2021.76598 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Büşra Tezcan ◽

Müçteba Can ◽

Çilem Bayındır Dicle ◽

İbrahim Mungan ◽

Derya Ademoğlu

Keyword(s):

Hospital Mortality ◽

Tertiary Hospital ◽

Rapid Response ◽

Rapid Response System ◽

Response System ◽

System Activation

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Trends of in-hospital cardiac arrests in a single tertiary hospital with a mature rapid response system

PLoS ONE ◽

10.1371/journal.pone.0262541 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262541

Author(s):

Hohyung Jung ◽

Ryoung-Eun Ko ◽

Myeong Gyun Ko ◽

Kyeongman Jeon

Keyword(s):

Hospital Mortality ◽

Poisson Regression ◽

Regression Models ◽

Tertiary Hospital ◽

Rapid Response ◽

Rapid Response System ◽

Quality Metric ◽

Response System ◽

Annual Changes ◽

General Wards

Background Most studies on rapid response system (RRS) have simply focused on its role and effectiveness in reducing in-hospital cardiac arrests (IHCAs) or hospital mortality, regardless of the predictability of IHCA. This study aimed to identify the characteristics of IHCAs including predictability of the IHCAs as our RRS matures for 10 years, to determine the best measure for RRS evaluation. Methods Data on all consecutive adult patients who experienced IHCA and received cardiopulmonary resuscitation in general wards between January 2010 and December 2019 were reviewed. IHCAs were classified into three groups: preventable IHCA (P-IHCA), non-preventable IHCA (NP-IHCA), and inevitable IHCA (I-IHCA). The annual changes of three groups of IHCAs were analyzed with Poisson regression models. Results Of a total of 800 IHCA patients, 149 (18.6%) had P-IHCA, 465 (58.1%) had NP-IHCA, and 186 (23.2%) had I-IHCA. The number of the RRS activations increased significantly from 1,164 in 2010 to 1,560 in 2019 (P = 0.009), and in-hospital mortality rate was significantly decreased from 9.20/1,000 patients in 2010 to 7.23/1000 patients in 2019 (P = 0.009). The trend for the overall IHCA rate was stable, from 0.77/1,000 patients in 2010 to 1.06/1,000 patients in 2019 (P = 0.929). However, while the incidence of NP-IHCA (P = 0.927) and I-IHCA (P = 0.421) was relatively unchanged over time, the incidence of P-IHCA decreased from 0.19/1,000 patients in 2010 to 0.12/1,000 patients in 2019 (P = 0.025). Conclusions The incidence of P-IHCA could be a quality metric to measure the clinical outcomes of RRS implementation and maturation than overall IHCAs.

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