title: Introduction of a rapid response system at a United States veterans affairs hospital reduced cardiac arrests.
abstract: BACKGROUND
  We sought to determine the impact of a rapid response system on cardiac arrest rates and mortality in a United States veteran population.
  
  
  METHODS
  We describe a prospective analysis of cardiac arrests in 9 months before and 27 months after institution of a rapid response system, and retrospective analysis of mortality 3.5 years before the intervention and 27 months after the intervention. The study included all inpatients from a university-affiliated United States Veterans Affairs Medical Center, before and after implementation of a rapid response system, including an educational program, patient calling criteria, and a physician-led medical emergency team. Primary end points were hospital-wide cardiac arrests and mortality rates normalized to hospital discharges. Comparisons of event rates between various time points during the implementation process were made by analysis of variance.
  
  
  RESULTS
  Three hundred seventy-eight calls were made to the medical emergency team in the time period studied. Compared with preintervention time points, cardiac arrests were reduced by 57%, amounting to a reduction of 5.6 cardiac arrests per 1000 hospital discharges (P < 0.01). Mortality was reduced during the intervention, but this was attributable to a natural decrease occurring over all phases of the study.
  
  
  CONCLUSIONS
  A significant reduction in the rate of cardiac arrests was realized with this intervention, as well as a trend toward lower mortality. We estimate that 51 arrests were prevented in the timeframe studied. Our results suggest that further reductions in morbidity can be realized by expansion of rapid response systems throughout the Veterans Affairs network.
authors.affiliation: Department of Anesthesiology, MC 112A, Veterans Affairs Medical Center, Palo Alto, CA 94304, USA. geoffL@stanford.ed
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Lighthall
authors.forename: Layla M
authors.initials: LM
authors.lastname: Parast
authors.forename: Lisa
authors.initials: L
authors.lastname: Rapoport
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010348:Patient Care Team; D011446:Prospective Studies; D020379:Risk Adjustment; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans