PURPOSE: Rapid Response Teams (RRTs) have been increasingly used as a strategy to improve patient outcomes in institutions without 24/7 on-site physician coverage. This study was conducted to determine if an additional benefit could be achieved from implementing a designated RRT in our institution with 24/7 presence of attending physicians.
METHODS: Our institution is an inner-city university affiliated teaching hospital with 24/7 coverage by board-certified attending physicians in all specialties. Distinct criteria were developed to recognize warning signs for patients deteriorating in hospital (Table-1). A RRT comprising of a senior ICU resident along with a nurse and respiratory therapist was implemented in June 2006. When a patient met the criteria, respective physicians covering the Medical/Surgical and Obstetric & Gynecology (OB/GYN) floors were first called with a 911 page. RRT was activated if the primary team did not respond within 3 minutes. Data related to activations and standard clinical outcomes were prospectively collected.
RESULTS: Results of the study for a 10-month period from June 2006 are presented in Table-2. Criteria for deterioration were identified in 1090 patients. Utilization of the primary team was significantly higher compared to RRT (98.3 vs 1.3%;p-value < 0.05). Average monthly mortality on floors was 1.24%, while the median cardio-pulmonary arrests per 1000 discharges was 2.45. Patients transferred to ICU as a result of the response from the primary team were significantly higher compared to RRT (3.4% vs 0.15%; p-value< 0.05). No additional staffing was required during the study.
CONCLUSION: Hospital-wide RRT was rarely utilized in our hospital given the continuous presence of attending physicians in-hospital. Clinical outcomes reported from this study are significantly better than those published in literature. To our knowledge, this is the first system to incorporate unique criteria to recognize patients deteriorating on Obstetric & Gynecology floors.
CLINICAL IMPLICATIONS: Our experience does not support the need for a RRT in an institution with 24/7 on-site attending coverage. Using criteria specific to the specialty-care areas can enhance the ability to recognize declining physiologic parameters on in-patient floors.
DISCLOSURE: Raghu Loganathan, No Financial Disclosure Information; No Product/Research Disclosure Information