title: Evaluating implementation of a rapid response team: considering alternative outcome measures.
abstract: OBJECTIVE
  Determine the prolonged effect of rapid response team (RRT) implementation on failure to rescue (FTR).
  
  
  METHODS
  Longitudinal study of institutional performance with control charts and Bayesian change point (BCP) analysis.
  
  
  METHODS
  Two academic hospitals in Midwest, USA.
  
  
  METHODS
  All inpatients discharged between 1 September 2005 and 31 December 2010.
  
  
  METHODS
  Implementation of an RRT serving the Mayo Clinic Rochester system was phased in for all inpatient services beginning in September 2006 and was completed in February 2008.
  
  
  METHODS
  Modified version of the AHRQ FTR measure, which identifies hospital mortalities among medical and surgical patients with specified in-hospital complications.
  
  
  RESULTS
  A decrease in FTR, as well as an increase in the unplanned ICU transfer rate, occurred in the second-year post-RRT implementation coinciding with an increase in RRT calls per month. No significant decreases were observed pre- and post-implementation for cardiopulmonary resuscitation events or overall mortality. A significant decrease in mortality among non-ICU discharges was identified by control charts, although this finding was not detected by BCP or pre- vs. post-analyses.
  
  
  CONCLUSIONS
  Reduction in the FTR rate was associated with a substantial increase in the number of RRT calls. Effects of RRT may not be seen until RRT calls reach a sufficient threshold. FTR rate may be better at capturing the effect of RRT implementation than the rate of cardiac arrests. These results support prior reports that short-term studies may underestimate the impact of RRT systems, and support the need for ongoing monitoring and assessment of outcomes to facilitate best resource utilization.
authors.affiliation: Health Care Policy and Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. naessens@mayo.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: Nicola E
authors.initials: NE
authors.lastname: Schiebel
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Johnson
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Jensen
authors.forename: Sean M
authors.initials: SM
authors.lastname: Caples
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Morlan
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Huddleston
authors.forename: Marianne
authors.initials: M
authors.lastname: Huebner
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
mesh_terms: D001499:Bayes Theorem; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D016730:Program Development; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012151:Resuscitation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data
keywords: failure to rescue; longitudinal evaluation; quality indicators; quality measures; rapid response team