Abstract
IntroductionAlthough 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.MethodWe 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.ResultsTwenty-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.ConclusionRapid 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0973-y) contains supplementary material, which is available to authorized users.
Highlights
Rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain
Nineteen studies (65.5 %) reported physicians as part of the rapid response system (RRS) team for 24 hours per day and 7 days per week, two studies only had physician presence for office hours Monday to Friday, seven studies had no physician presence and one study did not report on the composition of the team
In a systematic review and meta-analysis of 29 studies we found that a RRS team was associated with a reduction in hospital mortality in both adult and paediatric hospital populations
Summary
Rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. Patients often show some signs of physiological deterioration for several hours (median 6 hours) before cardiac arrest [2, 3] This would appear to be sufficient time to deliver interventions that would alter the trajectory of deterioration. This ‘failure to rescue’ is the context in which rapid response systems (RRSs) have been introduced [4]. Most RRS trials have used similar criteria for activation of the team These include various thresholds for respiratory rate, heart rate, blood pressure and mental state as well as the ‘staff worried’ criterion [5]. The time spent implementing and maintaining the concept of a RRS and the rate of RRS activation may be a contributory factor to its success
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