title: Effects of a rapid response system on quality of life: a prospective cohort study in surgical patients before and after implementing a rapid response system.
abstract: BACKGROUND
  The aim of a rapid response system (RRS) is to improve the timely recognition and treatment of ward patients with deteriorating vital signs The system is based on a set of clinical criteria that are used to assess patient's vital signs on a general ward. Once a patient is evaluated as critical, a medical emergency team is activated to more thoroughly assess the patient's physical condition and to initiate treatment. The medical emergency team included a critical care physician and a critical care nurse.
  
  
  OBJECTIVE
  To assess the effect of an RRS on health-related quality of life (HRQOL).
  
  
  METHODS
  Prospective cohort study in surgical patients before and after implementing an RRS. HRQOL was measured using the EuroQol-5 dimensions (EQ-5D) and the EQ visual analogue scale (VAS) at pre surgery and at 3 and 6 months following surgery.
  
  
  RESULTS
  No statistical significant effects of RRS implementation on the EQ-5D index and EQ-VAS were found. This was also true for the subpopulation of patients with an unplanned intensive care unit admission. Regarding the EQ-5D dimensions, deterioration in the 'mobility' and 'usual activities' dimensions in the post-implementation group was significantly less compared to the pre-implementation group with a respective mean difference of 0.08 (p = 0.03) and 0.09 (p = 0.04) on a three-point scale at 6 months. Lower pre-surgery EQ-5D index and higher American Society of Anesthesiologists physical status (ASA-PS) scores were significantly associated with lower EQ-5D index scores at 3 and 6 months following surgery.
  
  
  CONCLUSIONS
  Implementation of an RRS did not convincingly affect HRQOL following major surgery. We question if HRQOL is an adequate measure to assess the influence of an RRS. Pre-surgery HRQOL- and ASA-PS scores were strongly associated with HRQOL outcomes and may have abated the influence of the RRS implementation.
authors: Faculty of Health and Social Studies, HAN University of Applied Sciences, PO Box 6960, Nijmegen, 6503 GL, The Netherlands. Friede.Simmes@HAN.nl
authors: Friede
authors: F
authors: Simmes
authors: Lisette
authors: L
authors: Schoonhoven
authors: Joke
authors: J
authors: Mintjes
authors: Bernard G
authors: BG
authors: Fikkers
authors: Johannes G
authors: JG
authors: van der Hoeven
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000592:standards*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires / Q000592:standards
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