Sustained effectiveness of a primary-team-based rapid response system.
OBJECTIVE
Laws and regulations require many hospitals to implement rapid-response systems. However, the optimal resource intensity for such systems is unknown. We sought to determine whether a rapid-response system that relied on a patient's usual care providers, not a critical-care-trained rapid-response team, would improve patient outcomes.


METHODS
An interrupted time-series analysis of over a 59-month period.


METHODS
Urban, academic hospital.


METHODS
One hundred seven-one thousand, three hundred forty-one consecutive adult admissions.


METHODS
In the intervention period, patients were monitored for predefined, standardized, acute, vital-sign abnormalities or marked nursing concern. If these criteria were met, a team consisting of the patient's existing care providers was assembled.


RESULTS
The unadjusted risk of unexpected mortality was 72% lower (95% confidence interval 55%-83%) in the intervention period (absolute risk: 0.02% vs. 0.09%, p < .0001). The unadjusted in-hospital mortality rate was not significantly lower (1.9% vs. 2.1%, p = .07). After adjustment for age, gender, race, season of admission, case mix, Charlson Comorbidity Index, and intensive care unit bed capacity, the intervention period was associated with an 80% reduction (95% confidence interval 63%-89%, p < .0001) in the odds of unexpected death, but no significant change in overall mortality [odds ratio 0.91 (95% confidence interval 0.82-1.02), p = .09]. Analyses that also adjusted for secular time trends confirmed these findings (relative risk reduction for unexpected mortality at end of intervention period: 65%, p = .0001; for in-hospital mortality, relative risk reduction = 5%, p = .2).


CONCLUSIONS
A primary-team-based implementation of a rapid response system was independently associated with reduced unexpected mortality. This system relied on the patient's usual care providers, not an intensive care unit based rapid response team, and may offer a more cost-effective approach to rapid response systems, particularly for systems with limited intensivist availability.
Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, Boston, MA, USA. mhowell@bidmc.harvard.edu
Michael D
MD
Howell
Long
L
Ngo
Patricia
P
Folcarelli
Julius
J
Yang
Lawrence
L
Mottley
Edward R
ER
Marcantonio
Kenneth E
KE
Sands
Donald
D
Moorman
Mark D
MD
Aronson
D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration; D017052:Hospital Mortality / Q000639:trends*; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome