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International Journal of Emergency Medicine
Published in: International Journal of Emergency Medicine 1/2019

Open Access 01-12-2019 | Original Research

Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study

Authors: Awad Al-Omari, Abbas Al Mutair, Fadi Aljamaan

Published in: International Journal of Emergency Medicine | Issue 1/2019

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Abstract

Background

Cardiopulmonary arrest may result in high mortality rate in hospitals where the rapid response team is not implemented. A rapid response system can recognize patients at high risk of cardiopulmonary arrest and provide the needed medical management to prevent further deterioration. The rapid response system has shown a dramatic reduction in mortality rate and cardiopulmonary arrest.

Objective

To evaluate the effectiveness of the rapid response team (RRT) implementation in reducing the mortality rate, number of cardiopulmonary arrests, and number of ICU admission.

Design

A pre- and post-rapid response team system implementation.

Setting

Four tertiary private hospitals in Saudi Arabia.

Patients

A total of 154,869 patients in the 3-year before rapid response system period (January 2010 to December 2012) and a total of 466,161 during the 2.5-year post-RRT implementation period (January 2014 to June 2016).

Results

Results indicated that ward nurses activated RRT more often than physicians (1104 activations [69%] vs. 499 activations [31%]), with cardiovascular and respiratory abnormalities being the most common triggers. Serious concern about the patient condition by the ward staff was the trigger for 181 (11.29%) activations. The RRT provided a variety of diagnostic and therapeutic interventions. Most patients cared for by RRT were admitted to ICU 1103 (68.81%), and the rest 500 (31.19%) were managed in the ward. After the implementation of the RRT project, the hospital mortality rate dropped from 7.8 to 2.8 per 1000 hospital admission. Hospital cardiopulmonary arrest rate has dropped from 10.53 per 1000 hospital admissions to 2.58. Rapid response team implementation also facilitated end-of-life care discussions.

Conclusion

Implementation of the RRT project has shown a dramatic reduction in the total ICU admissions, average ICU occupancy rate, total hospital mortality, and total ICU mortality. These findings reinforce the evidence that RRT implementation is effective in reducing hospital mortality and cardiopulmonary arrest rates in addition to other outcomes related to healthcare quality.
Literature
1.
Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365:139.CrossRef
2.
Schein RM, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388.CrossRef
3.
Kause J, Smith G, Prytherch D, et al. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study. Resuscitation. 2004;62:275.CrossRef
4.
Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34:2463.CrossRef
5.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179(6):283–8.CrossRef
6.
Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, Cope J, Hart D, Kay D, Cowley K, Pateraki J. Introducing critical care outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med. 2004;30(7):1398–404.CrossRef
7.
Bristow PJ, Hillman KM, Chey T, Daffurn K, Jacques TC, Norman SL, Bishop GF, Simmons EG. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust. 2000;173(5):236–40.CrossRef
8.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32(4):916–21.CrossRef
9.
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(21):2506–13.CrossRef
10.
Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19(1):254.CrossRef
11.
Jones D, Baldwin I, McIntyre T, Story D, Mercer I, Miglic A, Goldsmith D, Bellomo R. Nurses’ attitudes to a medical emergency team service in a teaching hospital. BMJ Qual Saf. 2006;15(6):427–32.CrossRef
12.
Bagshaw SM, Mondor EE, Scouten C, Montgomery C, Slater-MacLean L, Jones DA, Bellomo R, Gibney RN, Capital Health Medical Emergency Team Investigators. A survey of nurses’ beliefs about the medical emergency team system in a Canadian tertiary hospital. Am J Crit Care. 2010;19(1):74–83.CrossRef
13.
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(3):324–7.CrossRef
14.
Day V, Expert group. Comprehensive critical care: a review of adult critical care services. London: Department of Health; 2000.
15.
O'Rourke M. The Australian Commission on Safety and Quality in Health Care agenda for improvement and implementation. Asia Pacific Journal of Health Management. 2007;2(2):21.
16.
Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A, Merit Study Investigators. The objective medical emergency team activation criteria: a case–control study. Resuscitation. 2007;73(1):62–72.CrossRef
17.
Chen J, Bellomo R, Flabouris A, Hillman K, Finfer S. The relationship between early emergency team calls and serious adverse events. Crit Care Med. 2009;37(1):148–53.CrossRef
18.
Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J, Frankel LR, Roth SJ. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. Jama. 2007;298(19):2267–74.CrossRef
19.
Al-Qahtani S, Al-Dorzi HM, Tamim HM, Hussain S, Fong L, Taher S, Al-Knawy BA, Arabi Y. Impact of an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. Crit Care Med. 2013;41(2):506–17.CrossRef
20.
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(7334):387–90.CrossRef
21.
Brilli RJ, Gibson R, Luria JW, Wheeler TA, Shaw J, Linam M, Kheir J, McLain P, Lingsch T, Hall-Haering A, McBride M. 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(3):236–46.CrossRef
22.
Morris DS, Schweickert W, Holena D, Handzel R, Sims C, Pascual JL, Sarani B. Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses. Resuscitation. 2012;83(12):1434–7.CrossRef
23.
Karvellas CJ, de Souza IA, Gibney RN, Bagshaw SM. Association between implementation of an intensivist-led medical emergency team and mortality. BMJ Qual Saf. 2012;21(2):152–9.CrossRef
Metadata
Title
Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study
Authors
Awad Al-Omari
Abbas Al Mutair
Fadi Aljamaan
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2019
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-019-0248-5

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