Implementation of a rapid response team decreases cardiac arrest outside of the intensive care unit.

BACKGROUND Patient safety and preventable inhospital mortality remain crucial aspects of optimum medical care and continue to receive public scrutiny. Signs of physiologic instability often precede overt clinical deterioration in many patients. The purpose of this study was to evaluate our early experience with implementation of a rapid response team (RRT) which would evaluate and treat nonintensive care unit (nonICU) patients with early signs of physiologic instability. We hypothesized that early evaluation and intervention before deterioration would avoid progression to cardiac arrest in patients. METHODS In March 2005, our urban Level I trauma center implemented an RRT to react to patient clinical deterioration; in effect, bringing critical care to the bedside. This team is available 24 hours/day, 7 seven days/week and consists of an intensivist, an ICU nurse, and a respiratory therapist. Activation criteria include pulse<40 or>130 beats per minute, systolic blood pressure<90 mm Hg, respiratory rate<8 or>24 breaths per minute, seizure, an acute change in mental status, or nursing staff concern for any other reason. Data were prospectively collected, including the number of RRT activations and the occurrence of inhospital cardiac arrest. RESULTS Between March and December 2005, the RRT was activated 76 times. All RRT activations were reviewed and thought to be appropriate. During the same time period the year before initiation of the RRT, there were 27 nonICU cardiac arrests. After RRT implementation, there were 13 cardiac arrests that occurred on the floor, representing just over a 50% reduction in cardiac arrest. Medical staff feedback regarding the RRT was uniformly positive. CONCLUSIONS Implementation of the RRT was well received by the hospital staff. Despite initial concerns to the contrary, the RRT was not over utilized. RRT activation resulted in early patient transfer to a higher level of care and avoided progression to cardiac arrest.

[1]  M. Devita,et al.  Impact of patient monitoring on the diurnal pattern of medical emergency team activation* , 2006, Critical care medicine.

[2]  B. Winters,et al.  Patient-safety and quality initiatives in the intensive-care unit , 2006, Current opinion in anaesthesiology.

[3]  Daryl A Jones,et al.  Introduction of a rapid response system: why we are glad we MET , 2006, Critical care.

[4]  K. Hillman,et al.  Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial , 2005, The Lancet.

[5]  J. Nolan,et al.  Observations and warning signs prior to cardiac arrest. Should a medical emergency team intervene earlier? , 2005, Acta anaesthesiologica Scandinavica.

[6]  M. Devita,et al.  Use of medical emergency team responses to reduce hospital cardiopulmonary arrests , 2004, Quality and Safety in Health Care.

[7]  J. Szalados.  Critical care teams managing floor patients: the continuing evolution of hospitals into intensive care units? , 2004, Critical care medicine.

[8]  Rinaldo Bellomo,et al.  Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates* , 2004, Critical care medicine.

[9]  The medical emergency team: does it really make a difference? , 2003, Internal medicine journal.

[10]  S. Ridley,et al.  Impact of an Outreach team on re‐admissions to a critical care unit , 2003, Anaesthesia.

[11]  T. Hodgetts,et al.  The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. , 2002, Resuscitation.

[12]  G. Moore,et al.  Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study , 2002, BMJ : British Medical Journal.

[13]  K. Hillman,et al.  The Medical Emergency Team: 12 month analysis of reasons for activation, immediate outcome and not-for-resuscitation orders. , 2001, Resuscitation.

[14]  Y. Salamonson,et al.  The evolutionary process of Medical Emergency Team (MET) implementation: reduction in unanticipated ICU transfers. , 2001, Resuscitation.

[15]  K. Hillman,et al.  Redefining in-hospital resuscitation: the concept of the medical emergency team. , 2001, Resuscitation.

[16]  C. Gwinnutt,et al.  Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. , 2000, Resuscitation.

[17]  A. Gawande,et al.  The incidence and nature of surgical adverse events in Colorado and Utah in 1992. , 1999, Surgery.

[18]  A. Smith,et al.  Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. , 1997, Resuscitation.

[19]  R. Gibberd,et al.  The Quality in Australian Health Care Study , 1995, The Medical journal of Australia.

[20]  K. Hillman,et al.  The Medical Emergency Team , 1995, Anaesthesia and intensive care.

[21]  C. Franklin,et al.  Developing strategies to prevent inhospital cardiac arrest: Analyzing responses of physicians and nurses in the hours before the event , 1994, Critical care medicine.

[22]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[23]  C. Sprung,et al.  Clinical antecedents to in-hospital cardiopulmonary arrest. , 1990, Chest.

[24]  R. Mcgrath.  In-house cardiopulmonary resuscitation--after a quarter of a century. , 1987, Annals of emergency medicine.