We first talked about Rapid Response Teams in our August 2007 What’s New in the Patient Safety World column “”. Then, in our Novermber 27, 2007 Patient Safety Tip of the Week “ ” we discussed the weakness of the evidence supporting a positive effect of rapid response teams on patient outcomes and discussed many of the methodological problems in studies on RRT’s.
Chan and colleagues (Chan 2008) have just published a prospective cohort design study comparing code rates and mortality before and after implementation of rapid response teams for adult inpatients. Raw code rates per 1000 admissions were lower in the the post-RRT period. However, after adjustment for a number of variables, overall hospital codes rates were not significantly reduced, though those for non-ICU patients were reduced. Furthermore, mortality was not significantly better after implementation of the RRT program. A significant finding in their study is that a large percentage of patients who died after RRT intervention either had DNR status or were accorded DNR status during or after the RRT intervention.
The study did not include financial data. However, in addition to the costs of developing and staffing the RRT’s, it should be noted that a substantial number of patients were bumped up to a higher level of care (usually ICU or telemetry service) after RRT intervention, thus adding to overall costs without significantly affecting outcomes (at least in terms of mortality).
All this negative evidence does not negate the logic of having a culture of safety that helps recognize early patients that are in need of “rescue”. But it does raise many questions about committing many resources to develop RRT’s without better evidence-based validation of the RRT concept. The idea remains a sound one but the most appropriate targets, the triggers, the makeup of teams, the mode of response, the logistics, and the best outcome measures all need to be validated before hospitals rush willy-nilly into developing RRT’s.
Update: See also our April 2009 What’s New in the Patient Safety World “Early Emergency Team Calls Reduce Serious Adverse Events” and our December 29, 2009 Patient Safety Tip of the Week “Recognizing Deteriorating Patients”.
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):2506-2513