title: Impact of a standardized rapid response system on outcomes in a large healthcare jurisdiction.
abstract: To assess the impact of a standardized rapid response system (RRS) implemented across a large health care jurisdiction on reducing serious adverse events, hospital mortality and unexpected deaths.
  
  
  
  We conducted an interrupted time series (2007-2013) population-based study in the state of New South Wales (NSW), Australia to evaluate the impact of introducing a statewide standardized RRS (the between-the-flags [BTF] system) which employed a five-component intervention strategy. We studied 9,799,081 admissions in all 232 public hospitals in NSW. We studied changes in trends for annual rates of multiple key patient-centered outcomes before and after its introduction.
  
  
  
  Before the BTF system (2007-2009), there was a progressive decrease in mortality, cardiac arrest rates, cardiac arrests related mortality, and failure to rescue rates, but no changes in mortality rate among low mortality diagnostic related group (LMDRGs) patients. After the BTF program (2010-2013), the same trends continued for all outcomes with an overall (2013 vs 2007) 46% reduction in cardiac arrest rates; a 54% reduction in cardiac arrest related mortality rates; a 19% reduction in hospital mortality; a 35% decrease in failure to rescue rates (all Ps<0.001) over seven-years. In addition, there was a new 20% (p<0.001) mortality reduction among LMDRG patients (2013 vs 2007).
  
  
  
  The BTF program was associated with continued decrease in the overall cardiac arrests rates, deaths after cardiac arrest, hospital mortality and failure to rescue. In addition, among patients in the LMDRC group, it induced a new and significant post-intervention reduction in mortality which was never reported before.
authors: Simpson Centre for Health Services Research & Ingham Institute of Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: jackchen@unsw.edu.au.
authors: Jack
authors: J
authors: Chen
authors: Simpson Centre for Health Services Research & Ingham Institute of Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors: Lixin
authors: L
authors: Ou
authors: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors: Arthas
authors: A
authors: Flabouris
authors: Simpson Centre for Health Services Research & Ingham Institute of Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors: Ken
authors: K
authors: Hillman
authors: Intensive Care Unit, Austin Medical Centre, Melbourne, Victoria, Australia.
authors: Rinaldo
authors: R
authors: Bellomo
authors: Intensive Care Unit, Liverpool Hospital, Sydney, Australia.
authors: Michael
authors: M
authors: Parr
mesh_terms: D000328:Adult; D000368:Aged; D019985:Benchmarking; D003422:Critical Care / Q000379:methods / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D057209:Hospital Rapid Response Team / Q000458:organization & administration / Q000592:standards; D006760:Hospitalization / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D016019:Survival Analysis
keywords: Cardiopulmonary arrests; Medical emergency team; Rapid response system; Rapid response team