Presented by Dr CHU Po Ngai Alvin at the daily Journal Club, ICU, PYNEH, Hong Kong, on 18 May 2009
In the article "Paul S. Chan, MD, MSc; Adnan Khalid, MD; Lance S. Longmore, DO; Robert A. Berg, MD; Mikhail Kosiborod, MD; John A. Spertus, MD, MPH. Hospital-wide Code (cardiopulmonary arrest) Rates and Mortality Before and After Implementation of a Rapid Response Team. JAMA. 2008;300(21):2506-2513", the primary study outcomes were hospital-wide cardiopulmonary arrest rates per 1000 admissions and mortality rates per 100 admissions. Which of the following was incorrect:
A. The adjusted hospital-wide code rates were not significant before and after setting up of the Rapid Response Team.
B. Hospital-wide mortality was not improved.
C. The rapid response teams were led by experienced ICU doctors.
D. The optimal triggers for rapid response team activation have not been rigorously determined.
Answer: C
The rapid response teams was a nurse-led team composed of 2 experienced ICU nurses and a respiratory therapist to respond to all calls for adult inpatients.
Reference
Go to JAMA here.
Context Rapid response teams have been shown in adult inpatients to decrease cardiopulmonary arrest (code) rates outside of the intensive care unit (ICU). Because a primary action of rapid response teams is to transfer patients to the ICU, their ability to reduce hospital-wide code rates and mortality remains unknown.
Objective To determine rates of hospital-wide codes and mortality before and after implementation of a long-term rapid response team intervention.
Design, Setting, and Patients A prospective cohort design of adult inpatients admitted between January 1, 2004, and August 31, 2007, at Saint Luke’s Hospital, a 404-bed tertiary care academic hospital in Kansas City, Missouri. Rapid response team education and program rollout occurred from September 1 to December 31, 2005. A total of 24 193 patient admissions were evaluated prior to the intervention (January 1, 2004, to August 31, 2005), and 24 978 admissions were evaluated after the intervention (January 1, 2006, to August 31, 2007).
Intervention Using standard activation criteria, a 3-member rapid response team composed of experienced ICU staff and a respiratory therapist performed the evaluation, treatment, and triage of inpatients with evidence of acute physiological decline.
Main Outcome Measures Hospital-wide code rates and mortality, adjusted for preintervention trends.
Results There were a total of 376 rapid response team activations. After rapid response team implementation, mean hospital-wide code rates decreased from 11.2 to 7.5 per 1000 admissions. This was not associated with a reduction in the primary end point of hospital-wide code rates (adjusted odds ratio [AOR], 0.76 [95% confidence interval {CI}, 0.57-1.01]; P = .06), although lower rates of non-ICU codes were observed (non-ICU AOR, 0.59 [95% CI, 0.40-0.89] vs ICU AOR, 0.95 [95% CI, 0.64-1.43]; P = .03 for interaction). Similarly, hospital-wide mortality did not differ between the preintervention and postintervention periods (3.22 vs 3.09 per 100 admissions; AOR, 0.95 [95% CI, 0.81-1.11]; P = .52). Secondary analyses revealed few instances of rapid response team undertreatment or underuse that may have affected the mortality findings.
Conclusion In this large single-institution study, rapid response team implementation was not associated with reductions in hospital-wide code rates or mortality.