title: Benchmarking the use of a rapid response team by surgical services at a tertiary care hospital.
abstract: BACKGROUND
  Rapid response teams (RRT) are used to prevent adverse events in patients with acute clinical deterioration, and to save costs of unnecessary transfer in patients with lower-acuity problems. However, determining the optimal use of RRT services is challenging. One method of benchmarking performance is to determine whether a department's event rate is commensurate with its volume and acuity.
  
  
  METHODS
  Using admissions between 2009 and 2011 to 18 distinct surgical services at a tertiary care center, we developed logistic regression models to predict RRT activation, accounting for days at-risk for RRT and patient acuity, using claims modifiers for risk of mortality (ROM) and severity of illness (SOI). The model was used to compute observed-to-expected (O/E) RRT use by service.
  
  
  RESULTS
  Of 45,651 admissions, 728 (1.6%, or 3.2 per 1,000 inpatient days) resulted in 1 or more RRT activations. Use varied widely across services (0.4% to 6.2% of admissions; 1.39 to 8.73 per 1,000 inpatient days, unadjusted). In the multivariable model, the greatest contributors to the likelihood of RRT were days at risk, SOI, and ROM. The O/E RRT use ranged from 0.32 to 2.82 across services, with 8 services having an observed value that was significantly higher or lower than predicted by the model.
  
  
  CONCLUSIONS
  We developed a tool for identifying outlying use of an important institutional medical resource. The O/E computation provides a starting point for further investigation into the reasons for variability among services, and a benchmark for quality and process improvement efforts in patient safety.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN. Electronic address: dan.barocas@vanderbilt.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.affiliation: Vanderbilt University Medical School, Nashville, TN.
authors.forename: Chirag S
authors.initials: CS
authors.lastname: Kulahalli
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN.
authors.forename: April N
authors.initials: AN
authors.lastname: Kapu
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN; Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Administration Health System, Nashville, TN.
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN.
authors.forename: Chaochen Chad
authors.initials: CC
authors.lastname: You
authors.affiliation: Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN.
authors.forename: Lisa
authors.initials: L
authors.lastname: Weavind
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Roger
authors.initials: R
authors.lastname: Dmochowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000379:methods*; D005260:Female; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062072:Patient Acuity; D016016:Proportional Hazards Models; D011446:Prospective Studies; D058996:Quality Improvement; D012372:ROC Curve; D020379:Risk Adjustment; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: AUC; O/E; ROM; RRT; SOI; area under the curve; observed-to-expected; rapid response team; risk of mortality; severity of Illness