Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Rapid response systems: a systematic review and meta-analysis

Authors: Ritesh Maharaj, Ivan Raffaele, Julia Wendon

Published in: Critical Care | Issue 1/2015

Login to get access

Abstract

Introduction

Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.

Method

We conducted a systematic review of studies published from January 1, 1990, through 31 December 2013, using PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests.

Results

Twenty-nine eligible studies were identified. The studies were analysed in groups based on adult and paediatric trials that were further sub-grouped on methodological design. There were 5 studies that were considered either cluster randomized control trial, controlled before after or interrupted time series. The remaining studies were before and after studies without a contemporaneous control. The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81–0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76–0.89) in-patient population. There was substantial heterogeneity in both populations. The rapid response system team was also associated with a reduction in cardiopulmonary arrests in adults (RR 0.65, 95 % CI 0.61–0.70, p<0.001) and paediatric (RR=0.64 95 % CI 0.55–0.74) patients.

Conclusion

Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest. Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.
Appendix
Available only for authorised users
Literature
1.
2.
Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Med J Aust. 1999;171:22–5.PubMedCrossRef
3.
Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22:244–7.PubMedCrossRef
4.
5.
Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365:2091–7.PubMedCrossRef
6.
Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Detection and documentation of dementia and delirium in acute geriatric wards. Gen Hosp Psychiatry. 2004;26:31–5.PubMedCrossRef
7.
Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004;62:137–41.PubMedCrossRef
8.
Smith GB, Prytherch DR, Schmidt P, Featherstone PI, Knight D, Clements G, et al. Hospital-wide physiological surveillance—a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71:19–28.PubMedCrossRef
9.
Downey AW, Quach JL, Haase M, Haase-Fielitz A, Jones D, Bellomo R. Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med. 2008;36:477–81.PubMedCrossRef
10.
Chen J, Bellomo R, Flabouris A, Hillman K, Finfer S. Centre MSIftS and Group ACT. The relationship between early emergency team calls and serious adverse events. Crit Care Med. 2009;37:148–53.PubMedCrossRef
11.
Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A, et al. The objective medical emergency team activation criteria: a case–control study. Resuscitation. 2007;73:62–72.PubMedCrossRef
12.
Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, et al. Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med. 2004;30:1398–404.PubMedCrossRef
13.
Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA. Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA. 2008;300:2506–13.PubMedCrossRef
14.
Konrad D, Jaderling G, Bell M, Granath F, Ekbom A, Martling CR. Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med. 2010;36:100–6.PubMedCrossRef
15.
The Joint Commission announces the 2009 National Patient Safety Goals and requirements. Jt Comm Perspect. 2008;28:1, 11–5
16.
Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006;295:324–7.PubMedCrossRef
17.
Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med. 2010;170:18–26.PubMedCrossRef
18.
Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:417–25.PubMedPubMedCentralCrossRef
19.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.PubMedPubMedCentralCrossRef
20.
Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). Oxford, UK: The Cochrane Collaboration;2011
21.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179:283–7.PubMedCrossRef
22.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32:916–21.PubMedCrossRef
23.
Tibballs J, Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med. 2009;10:306–12.PubMedCrossRef
24.
Tibballs J, Kinney S, Duke T, Oakley E, Hennessy M. Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child. 2005;90:1148–52.PubMedPubMedCentralCrossRef
25.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.PubMedCrossRef
26.
27.
Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34:2463–78.PubMedCrossRef
28.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6, e1000100.PubMedPubMedCentralCrossRef
29.
30.
Harbord RM, Egger M, Sterne JA. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2006;25:3443–57.PubMedCrossRef
31.
Palmer TM, Peters JL, Sutton AJ, Moreno GG. Contour-enhanced funnel plots for meta-analysis. Stata J. 2008;8:242–54.CrossRef
32.
Harbord RM, Higgins JPT. Meta-regression in Stata. Stata J. 2008;8:493–519.CrossRef
33.
Woertman W, de Hoop E, Moerbeek M, Zuidema SU, Gerritsen DL, Teerenstra S. Stepped wedge designs could reduce the required sample size in cluster randomized trials. J Clin Epidemiol. 2013;66:752–8.PubMedCrossRef
34.
de Hoop E, Woertman W, Teerenstra S. The stepped wedge cluster randomized trial always requires fewer clusters but not always fewer measurements, that is, participants than a parallel cluster randomized trial in a cross-sectional design. In reply J Clin Epidemiol. 2013;66:1428.PubMedCrossRef
35.
Hartling L, Milne A, Hamm MP, Vandermeer B, Ansari M, Tsertsvadze A, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol. 2013;66:982–93.PubMedCrossRef
36.
DeVita MA, Bellomo R, Hillman K. Introduction to the rapid response systems series. Jt Comm J Qual Patient Saf. 2006;32:359–60.PubMed
37.
Morris DS, Schweickert W, Holena D, Handzel R, Sims C, Pascual JL, et al. Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses. Resuscitation. 2012;83:1434–7.PubMedPubMedCentralCrossRef
38.
Karvellas CJ, de Souza IA, Gibney RT, Bagshaw SM. Association between implementation of an intensivist-led medical emergency team and mortality. BMJ Qual Saf. 2012;21:152–9.PubMedCrossRef
39.
40.
Al-Qahtani S, Al-Dorzi HM, Tamim HM, Hussain S, Fong L, Taher S, et al. Impact of an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. Crit Care Med. 2013;41:506–17.PubMedCrossRef
41.
Baxter AD, Cardinal P, Hooper J, Patel R. Medical emergency teams at The Ottawa Hospital: the first two years. Can J Anaesth. 2008;55:223–31.PubMedCrossRef
42.
Beitler JR, Link N, Bails DB, Hurdle K, Chong DH. Reduction in hospital-wide mortality after implementation of a rapid response team: a long-term cohort study. Crit Care. 2011;15:R269.PubMedPubMedCentralCrossRef
43.
Bristow PJ, Hillman KM, Chey T, Daffurn K, Jacques TC, Norman SL, et al. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust. 2000;173:236–40.PubMedCrossRef
44.
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387–90.PubMedPubMedCentralCrossRef
45.
Campello G, Granja C, Carvalho F, Dias C, Azevedo LF, Costa-Pereira A. Immediate and long-term impact of medical emergency teams on cardiac arrest prevalence and mortality: a plea for periodic basic life-support training programs. Crit Care Med. 2009;37:3054–61.PubMedCrossRef
46.
Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35:2076–82.PubMedCrossRef
47.
DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, et al. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13:251–4.PubMedPubMedCentralCrossRef
48.
Hayani O, Al-Beihany A, Zarychanski R, Chou A, Kharaba A, Baxter A, et al. Impact of critical care outreach on hematopoietic stem cell transplant recipients: a cohort study. Bone Marrow Transplant. 2011;46:1138–44.PubMedCrossRef
49.
Howell MD, Ngo L, Folcarelli P, Yang J, Mottley L, Marcantonio ER, et al. Sustained effectiveness of a primary-team-based rapid response system. Crit Care Med. 2012;40:2562–8.PubMedPubMedCentralCrossRef
50.
Jones D, Opdam H, Egi M, Goldsmith D, Bates S, Gutteridge G, et al. Long-term effect of a medical emergency team on mortality in a teaching hospital. Resuscitation. 2007;74:235–41.PubMedCrossRef
51.
Kenward G, Castle N, Hodgetts T, Shaikh L. Evaluation of a medical emergency team one year after implementation. Resuscitation. 2004;61:257–63.PubMedCrossRef
52.
Lim SY, Park SY, Park HK, Kim M, Park HY, Lee B, et al. Early impact of medical emergency team implementation in a country with limited medical resources: a before-and-after study. J Crit Care. 2011;26:373–8.PubMedCrossRef
53.
Santamaria J, Tobin A, Holmes J. Changing cardiac arrest and hospital mortality rates through a medical emergency team takes time and constant review. Crit Care Med. 2010;38:445–50.PubMedCrossRef
54.
Shah SK, Cardenas Jr VJ, Kuo YF, Sharma G. Rapid response team in an academic institution: does it make a difference? Chest. 2011;139:1361–7.PubMedCrossRef
55.
Simmes FM, Schoonhoven L, Mintjes J, Fikkers BG, van der Hoeven JG. Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system. Annals Intensive Care. 2012;2:20.CrossRef
56.
Brilli RJ, Gibson R, Luria JW, Wheeler TA, Shaw J, Linam M, et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med. 2007;8:236–46. quiz 247.PubMedCrossRef
57.
Hanson CC, Randolph GD, Erickson JA, Mayer CM, Bruckel JT, Harris BD, et al. A reduction in cardiac arrests and duration of clinical instability after implementation of a paediatric rapid response system. Postgrad Med J. 2010;86:314–8.PubMedCrossRef
58.
Haque A u, Saleem AF, Zaidi S, Haider SR. Experience of pediatric rapid response team in a tertiary care hospital in Pakistan. Indian J Pediatr. 2010;77:273–6.CrossRef
59.
Hunt EA, Zimmer KP, Rinke ML, Shilkofski NA, Matlin C, Garger C, et al. Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center. Arch Pediatr Adolesc Med. 2008;162:117–22.PubMedCrossRef
60.
Kotsakis A, Lobos AT, Parshuram C, Gilleland J, Gaiteiro R, Mohseni-Bod H, et al. Implementation of a multicenter rapid response system in pediatric academic hospitals is effective. Pediatrics. 2011;128:72–8.PubMedCrossRef
61.
Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J, et al. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA. 2007;298:2267–74.PubMedCrossRef
62.
Zenker P, Schlesinger A, Hauck M, Spencer S, Hellmich T, Finkelstein M, et al. Implementation and impact of a rapid response team in a children’s hospital. Jt Comm J Qual Patient Saf. 2007;33:418–25.PubMed
Metadata
Title
Rapid response systems: a systematic review and meta-analysis
Authors
Ritesh Maharaj
Ivan Raffaele
Julia Wendon
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0973-y

Other articles of this Issue 1/2015

Critical Care 1/2015 Go to the issue

Letter

2015, big data in healthcare: for whom the bell tolls?

Research

Renal tubular acidosis is highly prevalent in critically ill patients

Letter

Lung ultrasound in the critically ill (LUCI) and the lung point: a sign specific to pneumothorax which cannot be mimicked

Research

Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study

Review

Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12

Research

Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case–control study