Rapid Response Teams Make No Difference

Rapid response teams at hospitals shorten stays somewhat, but do not reduce mortality or transfers to intensive care units, according to a study in the Journal of Hospital Medicine.

The study was conducted at eight units at Barnes-Jewish Hospital in St. Louis between January and May 2013.

Patients were selected when they triggered an alert on the early warning system, which measures changes in vital signs.

“Such changes may precede clinical deterioration by hours, providing a chance to intervene if detected early enough,” says the report, “A Randomized Trial of Real-Time Automated Clinical Deterioration Alerts Sent to a Rapid Response Team.”

The study and control groups consisted of 257 patients each. The RRT team was a registered nurse, a second- or third-year internal medicine resident, and a respiratory therapist.

“Patients in the intervention group were significantly more likely to have their primary care team physician notified by an RRT nurse regarding medical condition issues and to have oximetry and telemetry started, whereas control patients were significantly more likely to have new antibiotic orders written within 24 hours of … an alert,” the study states.

The transfer rates to the ICU (17.8% and 18.2% respectively) was not statistically significant. Neither was the need for subsequent long-term care (26.9% for the RRT intervention group and 26.3% for the control group).

Length of stay for the intervention group was 8.4 days; for the control group, 9.4 days.

The alert system needs to be improved, the authors state:

“As a result of mandates from quality improvement organizations, most U.S. hospitals currently employ RRTs for emergent mobilization of resources when a clinically deteriorating patient is identified on a hospital ward. Linking RRT actions with a validated real-time alert may represent a way of improving the overall effectiveness of such teams for monitoring general hospital units, short of having all hospitalized patients in units staffed and monitored to provide higher levels of supervision (e.g., ICSs, step-down units).”

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