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

Awad Al-Omari,Fadi Aljamaan,Abbas Al Mutair

doi:10.1186/s12245-019-0248-5

Abstract

BackgroundCardiopulmonary 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.ObjectiveTo evaluate the effectiveness of the rapid response team (RRT) implementation in reducing the mortality rate, number of cardiopulmonary arrests, and number of ICU admission.DesignA pre- and post-rapid response team system implementation.SettingFour tertiary private hospitals in Saudi Arabia.PatientsA 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).ResultsResults 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.ConclusionImplementation 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.

Highlights

Cardiopulmonary arrest may result in high mortality rate in hospitals where the rapid response team is not implemented
Implementation of the Rapid response team (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

Summary

Introduction

Cardiopulmonary arrest may result in high mortality rate in hospitals where the rapid response team is not implemented. Rapid response team (RRT) system is implemented to identify the deteriorating hospitalized patients who show clinical warning signs [1,2,3]. The rationale of the RRT program is to improve the safety of those hospitalized patients whose condition is deteriorating quickly The identification of those patients is based on early notification, rapid intervention, and ongoing evaluation [4]. Patients at high risk are to be identified by the trained rapid response team that provides intervention based on each case individually and on an ongoing evaluation of the system’s performance [4]. The pre-intervention and postintervention design which was mainly adopted by most of the studies may have not adequately adjusted for the disease severity [1, 5,6,7,8,9]

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Discussion

Conclusion