title: The impact of implementing a rapid response system: a comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia.
abstract: OBJECTIVE
  To compare clinical outcomes between a teaching hospital with a mature rapid response system (RRS), with three similar teaching hospitals without a RRS in Sydney, Australia.
  
  
  METHODS
  For the period 2002-2009, we compared a teaching hospital with a mature RRS, with three similar teaching hospitals without a RRS. Two non-RRS hospitals began implementing the system in 2009 and a third in January 2010. We compared the rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality, overall hospital mortality and 1-year post discharge mortality after IHCA between the RRS hospital and the non-RRS hospitals based on three separate analyses: (1) pooled analysis during 2002-2008; (2) before-after difference between 2008 and 2009; (3) after implementation in 2009.
  
  
  RESULTS
  During the 2002-2008 period, the mature RRS hospital had a greater than 50% lower IHCA rate, a 40% lower IHCA-related mortality, and 6% lower overall hospital mortality. Compared to 2008, in their first year of RRS (2009) two hospitals achieved a 22% reduction in IHCA rate, a 22% reduction in IHCA-related mortality and an 11% reduction in overall hospital mortality. During the same time, the mature RRS hospital showed no significant change in those outcomes but, in 2009, it still achieved a crude 20% lower IHCA rate, and a 14% lower overall hospital mortality rate. There was no significant difference in 1-year post-discharge mortality for survivors of IHCA over the study period.
  
  
  CONCLUSIONS
  Implementation of a RRS was associated with a significant reduction in IHCA, IHCA-related mortality and overall hospital mortality.
authors.affiliation: Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: jackchen@unsw.edu.au.
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lixin
authors.initials: L
authors.lastname: Ou
authors.affiliation: Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Hillman
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital and School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Arthas
authors.initials: A
authors.lastname: Flabouris
authors.affiliation: Intensive Care Unit, Austin Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Hollis
authors.affiliation: Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Hassan
authors.initials: H
authors.lastname: Assareh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Cardiac arrests; Hospital mortality; Medical emergency team; Rapid response systems; Rapid response team; Unexpected deaths