• Michael D Howell, Long Ngo, Patricia Folcarelli, Julius Yang, Lawrence Mottley, Edward R Marcantonio, Kenneth E Sands, Donald Moorman, and Mark D Aronson.
• Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, Boston, MA, USA. mhowell@bidmc.harvard.edu
• Crit. Care Med.. 2012 Sep 1;40(9):2562-8.

ObjectiveLaws and regulations require many hospitals to implement rapid-response systems. However, the optimal resource intensity for such systems is unknown. We sought to determine whether a rapid-response system that relied on a patient's usual care providers, not a critical-care-trained rapid-response team, would improve patient outcomes.Design, Setting, And PatientsAn interrupted time-series analysis of over a 59-month period.SettingUrban, academic hospital.PatientsOne hundred seven-one thousand, three hundred forty-one consecutive adult admissions.InterventionIn the intervention period, patients were monitored for predefined, standardized, acute, vital-sign abnormalities or marked nursing concern. If these criteria were met, a team consisting of the patient's existing care providers was assembled.Measurements And Main ResultsThe unadjusted risk of unexpected mortality was 72% lower (95% confidence interval 55%-83%) in the intervention period (absolute risk: 0.02% vs. 0.09%, p < .0001). The unadjusted in-hospital mortality rate was not significantly lower (1.9% vs. 2.1%, p = .07). After adjustment for age, gender, race, season of admission, case mix, Charlson Comorbidity Index, and intensive care unit bed capacity, the intervention period was associated with an 80% reduction (95% confidence interval 63%-89%, p < .0001) in the odds of unexpected death, but no significant change in overall mortality [odds ratio 0.91 (95% confidence interval 0.82-1.02), p = .09]. Analyses that also adjusted for secular time trends confirmed these findings (relative risk reduction for unexpected mortality at end of intervention period: 65%, p = .0001; for in-hospital mortality, relative risk reduction = 5%, p = .2).ConclusionsA primary-team-based implementation of a rapid response system was independently associated with reduced unexpected mortality. This system relied on the patient's usual care providers, not an intensive care unit based rapid response team, and may offer a more cost-effective approach to rapid response systems, particularly for systems with limited intensivist availability.

33 keywords...

hide…