title: Long-term culture change related to rapid response system implementation.
abstract: OBJECTIVE
  Increasing attention to patient safety in training hospitals may come at the expense of trainee autonomy and professional growth. This study sought to examine changes in medical trainees' self-reported behaviour after the institution-wide implementation of a rapid response system.
  
  
  METHODS
  We conducted a two-point cross-sectional survey of medical trainees in 2006, during the implementation of a rapid response system, and in 2010, in a single academic medical centre. A novel instrument was used to measure trainee likelihood of calling for supervisory assistance, perception of autonomy, and comfort in managing decompensating patients. Non-parametric tests to assess for change were used and year of training was evaluated as an effect modifier.
  
  
  RESULTS
  Response rates were 38% in 2006 and 70% in 2010. After 5 years of the full implementation of the rapid response system, residents were significantly more likely to report calling their attending physicians for assistance (rising from 40% to 65% of relevant situations; p < 0.0001). Year of training was a significant effect modifier. Interns felt significantly more comfortable in managing acutely ill patients; juniors and seniors felt significantly less concerned about their autonomy at 5 years after the implementation of the rapid response system. These changes were mirrored in the actual use of the rapid response system, which increased by 41% during the 5-year period after adjustment for patient volume (p < 0.0001).
  
  
  CONCLUSIONS
  A primary team-focused implementation of a rapid response system was associated with durable changes in resident physicians' reported behaviour, including increased comfort with involving more experienced physicians and managing unstable patients.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stevens
authors.forename: Anna
authors.initials: A
authors.lastname: Johansson
authors.forename: Inga
authors.initials: I
authors.lastname: Lennes
authors.forename: Douglas
authors.initials: D
authors.lastname: Hsu
authors.forename: Anjala
authors.initials: A
authors.lastname: Tess
authors.forename: Michael
authors.initials: M
authors.lastname: Howell
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D004501:Education, Medical / Q000458:organization & administration; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006801:Humans; D061214:Patient Safety / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D017009:Professional Autonomy; D057566:Self Report