title: Rapid response team and hospital mortality in hospitalized patients.
abstract: OBJECTIVE
  Although rapid response systems are known to reduce in-hospital cardiac arrest rate, their effect on mortality remains debated. The present study aimed to evaluate the effect of implementing an intensivist-led rapid response team (RRT) on mortality in hospitalized patients.
  
  
  METHODS
  An implementation of an intervention and a comparison with retrospective data analysis were performed in the four hospitals of Montpellier regional healthcare centre, in France. An intensivist-led RRT was implemented on a 24/7 basis along with educational modules, publicity and bedside simulation-based training in only one of the four hospitals from January 2012 to June 2012. A single activation criterion (heart rate below 40/min or above 140/min, systolic blood pressure below 80 mmHg, cardiac arrest, respiratory rate below 8/min or above 30/min, pulse oximetry below 90% with O2 above 6 l/min, respiratory distress in a tracheotomised patient, respiratory arrest, coma or sudden change in level of consciousness, seizure) allowed any caregiver to directly contact the RRT using a dedicated cell phone number. Patients over 18 years admitted for more than 24 h in the medical-surgical wards from July 2010 to December 2011 (pre-RRT period) and from July 2012 to December 2013 (RRT period) were included. The main outcome was unexpected mortality. Analyses of data from one RRT hospital and three control hospitals (no RRT hospital) were performed.
  
  
  RESULTS
  RRT implementation was associated with a decrease in unexpected mortality rate in the hospital that implemented RRT (from 21.9 to 17.4 per 1000 discharges; p = 0.002). Reduction in unexpected mortality associated with RRT implementation could be estimated at 1.5 lives saved per week in the RRT hospital. In the three other hospitals, mortality rate was not significantly modified (from 19.5 to 19.9 per 1000 discharges; p = 0.69). Overall mortality decreased from 39.6 to 34.6 per 1000 discharges between the pre-RRT and RRT period in the RRT hospital (p = 0.012), but did not significantly change in the other hospitals. Patients in the RRT hospital were more frequently admitted to the intensive care unit (ICU) during the RRT period (45.8 vs 52.9 per 1000; p = 0.002), and their sequential organ failure assessment (SOFA) score upon ICU admission significantly decreased from 7 (4-10) to 5 (2-9); p < 0.001.
  
  
  CONCLUSIONS
  In the present retrospective study, implementation of an intensivist-led RRT along with educational modules, publicity and bedside simulation-based training was associated with a significant decrease in unexpected and overall mortality of inpatients.
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France.|Centre National de la Recherche Scientifique (CNRS 9214), Institut National de la Santé et de la Recherche Medicale (INSERM U-1046), Montpellier University, Montpellier, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Daurat
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France.|Centre National de la Recherche Scientifique (CNRS 9214), Institut National de la Santé et de la Recherche Medicale (INSERM U-1046), Montpellier University, Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France.|Centre National de la Recherche Scientifique (CNRS 9214), Institut National de la Santé et de la Recherche Medicale (INSERM U-1046), Montpellier University, Montpellier, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Mahul
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Monnin
authors.affiliation: Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 729 MISTEA, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, University of Montpellier, Saint Eloi Teaching Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France. s-jaber@chu-montpellier.fr.|Centre National de la Recherche Scientifique (CNRS 9214), Institut National de la Santé et de la Recherche Medicale (INSERM U-1046), Montpellier University, Montpellier, France. s-jaber@chu-montpellier.fr.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Cardiac arrest; Medical emergency team; Patient safety; Rapid response team