A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.
BACKGROUND
Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs.


OBJECTIVE
To determine if real-time alerts sent to the rapid response team (RRT) improved patient care.


METHODS
Randomized, controlled trial.


METHODS
Eight medicine units (Barnes-Jewish Hospital).


METHODS
Five hundred seventy-one patients.


METHODS
Real-time alerts generated by a validated deterioration algorithm were sent real-time to the RRT (intervention) or hidden (control).


METHODS
Intensive care unit (ICU) transfer, hospital mortality, hospital duration.


RESULTS
ICU transfer (17.8% vs 18.2%; odds ratio: 0.972; 95% confidence interval [CI]: 0.635-1.490) and hospital mortality (7.3% vs 7.7%; odds ratio: 0.947; 95% CI: 0.509-1.764) were similar for the intervention and control groups. The number of patients requiring transfer to a nursing home or long-term acute care hospital was similar for patients in the intervention and control groups (26.9% vs 26.3%; odds ratio: 1.032; 95% CI: 0.712-1.495). Hospital duration (8.4 ± 9.5 days vs 9.4 ± 11.1 days; P = 0.038) was statistically shorter for the intervention group. The number of RRT calls initiated by the primary care team was similar for the intervention and control groups (19.9% vs 16.5%; odds ratio: 1.260; 95% CI: 0.823-1.931).


CONCLUSIONS
Real-time alerts sent to the RRT did not reduce ICU transfers, hospital mortality, or the need for subsequent long term care. However, hospital length of stay was modestly reduced.
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri.
Marin H
MH
Kollef
Yixin
Y
Chen
Kevin
K
Heard
Gina N
GN
LaRossa
Chenyang
C
Lu
Nathan R
NR
Martin
Nelda
N
Martin
Scott T
ST
Micek
Thomas
T
Bailey
D000368:Aged; D003199:Computer Systems / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D057209:Hospital Rapid Response Team / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D050316:Medical Order Entry Systems / Q000639:trends*; D008875:Middle Aged; D010348:Patient Care Team / Q000639:trends*