Does the Initiation of a Hospital‐Wide Rapid Response Team Decrease the Incidence of Codes and Improve Both Survival and Survival to Discharge?

1Cleveland Clinic, Cleveland, OH
2Cleveland Clinic, Cleveland, OH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 53

Background:

Rapid response teams (RRTs) are a recent occurrence. There has been exponential growth in the number of RRTs in the United States and internationally. Discussion has ensued regarding their merit. The purpose of RRTs is to decrease the morbidity and mortality of hospitalized patients and increase in‐hospital cardiac arrest survival. The Joint Commission and the American Heart Association have endorsed the concept of an RRT. There has been debate regarding the value of RRTs with conflicting studies regarding their success.

Methods:

A RRT was started in January 2008 at a large, urban, academic tertiary‐care referral institution. The RRT responds to pages from the inpatient floors (excluding the ICU) RRT brings emergency medications, respiratory supplies including intubation equipment, intravenous line setups, and point‐of‐care testing (POC) to the patient's bedside. The RRT consists of a staff emergency department (ED) physician, RN, and respiratory therapist. The number of non‐ICU codes, initial survival, and survival to discharge for adults were compared for the year prior to beginning the RRT and the first year of the RRT. True CPR events were defined as no pulse and no respiration.

Results:

After the initiation of the RRT, the number of calls gradually increased over the first few months and reached the average number of RRT calls after 5 months of operation. However, even during the first few months of operation, when use of RRT was just getting started and there was a lower RRT call volume, a decrease in the number of true CPR arrests occurred. There was a decrease in codes for every month of the year in 2008 compared with 2007. In 1 month alone during the first year of RRT operation, true CPR arrests went from 28 to 17. There also was improved initial survival and survival to discharge for the first year of RT operation (2008) compared with the previous year (2007). For each quarter of 2008 versus 2007, there was an increase in initial survival and survival to discharge. There was also a trend toward fewer codes during the later months of the first year of operation of the RRT than during the early months in the year when RRT was just getting started.

Conclusions:

During the first year of the initiation of an RRT, there was a decreased incidence of codes outside the ICU and an increase in initial survival and survival to discharge compared with the prior year. These changes cannot be attributed to a major decrease in the numbers of patients because the numbers of patients during the years of the study remained essentially the same. Moreover, there was an actual increase in patient acuity, as indicated by acute case mix and by acute length of stay, indicating that the inpatients during the RRT year were sicker with a higher acuity than the previous year. In our institution, formation of an RRT appears to have improved both survival and survival to discharge, while simultaneously decreasing the number of codes.

To cite this abstract:

Mace S, Ahmed M. Does the Initiation of a Hospital‐Wide Rapid Response Team Decrease the Incidence of Codes and Improve Both Survival and Survival to Discharge?. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 53. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/does-the-initiation-of-a-hospitalwide-rapid-response-team-decrease-the-incidence-of-codes-and-improve-both-survival-and-survival-to-discharge/. Accessed November 16, 2019.

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