The effect of a rapid response team on major clinical outcome measures in a community hospital.
OBJECTIVE
To determine the effect of a rapid response system composed primarily of a rapid response team led by physician assistants on the rates of in-hospital cardiac arrests, total and unplanned intensive care unit admissions, and hospital mortality.


METHODS
Prospective, controlled, before and after trial.


METHODS
A 350-bed nonteaching community hospital.


METHODS
All adult patients admitted to the hospital from May 1, 2005, to October 1, 2006.


METHODS
We introduced a hospital-wide rapid response system that included a rapid response team (RRT) led by physician assistants with specialized critical care training.


RESULTS
We measured the incidence of cardiac arrests that occurred outside of the intensive care unit, total intensive care unit admissions, unplanned intensive care unit admissions, intensive care unit length of stay, and the total hospital mortality rate occurring over the study period. There were 344 RRT calls during the study period. In the 5 months before the rapid response system began, there were an average of 7.6 cardiac arrests per 1,000 discharges per month. In the subsequent 13 months, that figure decreased to 3.0 cardiac arrests per 1,000 discharges per month. Overall hospital mortality the year before the rapid response system was 2.82% and decreased to 2.35% by the end of the RRT year. The percentage of intensive care unit admissions that were unplanned decreased from 45% to 29%. Linear regression analysis of key outcome variables showed strong associations with the implementation of the rapid response system, as did analysis of variables over time. Physician assistants successfully managed emergency airway situations without assistance in the majority of cases.


CONCLUSIONS
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.
Dacey
Michael J
MJ
Critical Care Division and the Division of Hospitalist Medicine, Kent Hospital, Warwick, RI, USA. mikedaceymd@mac.com
Mirza
Ehsun Raza
ER
Wilcox
Virginia
V
Doherty
Maureen
M
Mello
James
J
Boyer
Amy
A
Gates
Jonathan
J
Brothers
Todd
T
Baute
Robert
R
D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000706:statistics & numerical data; D010823:Physician Assistants; D011446:Prospective Studies; D000078329:Workforce