Rapid response systemsClinical outcomes of patients seen by Rapid Response Teams: A template for benchmarking international teams☆
Introduction
Patients admitted to hospital wards have increasingly complex conditions and multiple co-morbidities.1, 2 Rapid Response Teams (RRTs) and similar services have been introduced to identify, review and treat at-risk and deteriorating ward patients in an attempt to reduce serious adverse events, cardiac arrests, and unplanned admissions to the intensive care unit (ICU).3, 4 The characteristics of patients subject to RRT review5 and typical triggers for RRT calls6 are known. At the same time in-hospital mortality rate of patients seen by RRTs is in the order of 20%.7, 8, 9, 10
Most of the literature related to RRTs evaluates the effects of introducing a RRT on outcomes of all hospitalized patients. Less information exists about the immediate outcomes of individual patients after RRT review or how patient outcomes after RRT review may vary between countries. This information is important as results of RRT implementations are being reported from an increasing number of countries with divergent health care systems. Improvements such as those recently reported from a French group of hospitals11 might be due to changes in hospital culture or due to changes in outcomes of the group of sick patients seen by RRTs.
The purpose of this study was to examine the short-term (24 h) outcome of patients triggering RRT review and the variations in such outcomes between hospitals from different countries.
Section snippets
Definitions
For the purpose of this manuscript, the term Rapid Response Team (RRT) is used to describe Rapid Response Teams, Medical Emergency Teams or Critical Care Outreach Teams, and RRT denotes individuals or groups of health care professionals responding to deteriorating hospitalized patients in locations other than Intensive Care.
Ethics approval
The human ethics committee at each location approved participation, and data handling conformed to local practices. For the UK, we obtained formal approval from the Human
Baseline characteristics of study centres demographics
Fifty-one sites from Australia (3), Denmark (4) the Netherlands (1), the United Kingdom (40) and the United States (3) took part in the study. Participating hospitals had a median of 500 beds (IQR 400–762); the median number of new patients seen by teams during the study week was 25 (IQR 15–35). A comparison of the 40 UK and 11 non-UK sites based on the characteristics of their RRT in terms of model and leadership is shown in Table 1. The majority of UK RRTs were nurse led, compared to non-UK
Discussion
We studied the features, management, and immediate outcomes of 1188 general ward patients receiving Rapid Response Team review in 51 centres across five countries, and compared short-term patient outcomes in UK vs. non-UK hospitals. Overall, we found that approximately 1 patient in 10 died within 24 h; one quarter of calls resulted in ICU transfer, and one quarter resulted in changes to treatment limitations. Focusing on UK data we found, a higher frequency of ward deaths with “full care”
Conclusion
The present paper offers clinicians a standardized benchmarking dataset for short-term outcomes of RRT interventions. Within 24 h of an RRT event, 1 patient in 10 will be dead, 1 in 4 will be transferred to ICU, and 1 in 4 will have limitation of care orders. These results might differ between hospitals and countries. The factors contributing to these outcomes and differences in process of care require further exploration as does investigation of longer-term outcomes.
Conflict of Interest Statement
All contributing authors listed have no competing interests to declare.
Acknowledgements
Special thanks to the International Society for Rapid Response Systems (iSRRS) and the UK National Outreach Forum (NOrF) for their support and assistance in recruiting site investigators.
Collaborators consented to the statement that ‘Health Research Ethics Committee (HREC) approval has been obtained or need for HREC approval been waived locally.’ All ethics committees approached gave their approval.
The METHOD site investigators: [alphabetically by institution, all in the United Kingdom unless
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.07.001.
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On behalf of the Medical Emergency Teams: Hospital Outcomes in a Day (METHOD) study investigators. The Medical Emergency Team Hospital Outcomes in a Day (METHOD) investigators are listed in the Acknowledgements section.