STUDY INDICATES HOSPITAL RAPID RESPONSE TEAMS MAY NOT PREVENT CARDIAC ARRESTS, DEATHS.

It’s been reported that, "Hospital rapid response teams, created to prevent cardiac arrest and deaths in critically ill patients, do not seem to work," according to a study published in the Dec. 3,2008 issue of the Journal of the American Medical Association. Normally, rapid response teams are "made up of doctors, nurses and respiratory therapists, whose primary role is to care for patients in the intensive care unit (ICU)." The teams may also "help evaluate patients who are not in the ICU."

For the study, investigators analyzed "the use of rapid-response teams consisting of intensive-care unit nurses and respiratory therapists at 404-bed St. Luke's Hospital of Kansas City (Mo.), and their association with lower hospitalwide cardiopulmonary arrest and hospital mortality rates,"

It is also noted that the study revealed a four percent decline in mortality rates "after rapid-response teams were introduced in late 2005," and a 33 percent decline in "mean rates for hospital-wide cardiopulmonary arrest codes." But, "after accounting for other changes occurring in the same time frame, including hospital quality-improvement programs and improved technologies, the adjusted odds ratio of 0.76 failed to reach statistical significance."

A rapid response team, also known as a medical emergency team, is a multidisciplinary team of intensive care unit (ICU) personnel charged with the evaluation, triage, and treatment of non-ICU patients with signs of clinical deterioration to reduce the rates of in-hospital cardiopulmonary arrests (codes) and their attendant morbidity and mortality. Several studies have shown that rates of non-ICU codes decrease after rapid response team implementation,7-11 but these studies, which have focused on cardiopulmonary arrests outside of the ICU, may lead to a favorable bias for rapid response teams because cardiac arrests that occurred after transferring patients with physiological decline to the ICU were not included.

In-hospital cardiac arrests are common and delays in treatment are associated with lower survival and worse neurological outcomes. Prior studies have reported that adult patients often exhibit physiological deterioration hours before cardiopulmonary arrest. As a result, the Institute for Healthcare Improvement recommended in their 100 000 Lives Campaign that hospitals implement rapid response teams as 1 of 6 strategies to reduce preventable in-hospital deaths. In response, hundreds of hospitals around the country have invested significant financial and personnel resources in implementing rapid response teams, despite the fact that limited published data support their
effectiveness.

The authors found no differences in length of hospital stay (ie, median exposure time to codes) was seen across the study years. We found that implementation of a rapid response team was not associated with lower hospital-wide code rates. Similarly, rapid response team intervention was not associated with improvements in the clinically meaningful outcome of hospital-wide mortality. Importantly, only a small percentage of deaths after rapid response team intervention and cardiopulmonary arrests were categorized as potential rapid response team undertreatment or underuse and would not have plausibly altered these findings. We believe that this study provides important new insights regarding the effectiveness and limitations of rapid response team intervention and raises critical questions about whether recommendations to disseminate rapid response teams nationally are warranted without a demonstrable mortality benefit.

Implementation of a rapid response team in the author’s tertiary care adult hospital was not associated with lower rates of either hospital-wide cardiopulmonary arrests or mortality.

Because of the lack of robust outcomes after the rapid response team intervention, well-designed multicenter adequately powered randomized controlled trials with sufficiently long follow-up should be considered to rigorously evaluate the efficacy of rapid response teams prior to endorsing their widespread implementation.

Paul S. Chan et al. Hospital-wide Code Rates and Mortality Before and After Implementation of a Rapid Response Team. JAMA. 2008;300(21):2506-2513.