Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: A systematic review and meta-analysis.

BACKGROUND In 2004, the Institute for Healthcare Improvement's 100,000 Lives Campaign recommended that hospitals implement rapid response teams (RRTs) charged with identifying non-intensive care unit (ICU) patients at risk for rapid deterioration. Although RRTs are now in widespread use, there have been conflicting results regarding the impact of RRTs on hospital mortality and cardiopulmonary arrest. PURPOSE To assess the effectiveness of RRTs on reducing hospital mortality and non-ICU cardiopulmonary arrest rates. DATA SOURCES We conducted a systematic review using MEDLINE (1966-2014), Cochrane Central Register of Controlled Trials (1898-2014), Cumulative Index to Nursing and Allied Health Literature (1994-2014), and ClinicalTrials.gov (1997-2014) during October 2014. There were no constraints on language or publication status. DATA EXTRACTION We included before-after studies, cohort studies, and cluster randomized trials that reported hospital mortality and/or non-ICU cardiopulmonary arrest for adults hospitalized in a non-ICU setting after the implementation of RRTs and/or medical emergency teams (METs). Data were extracted by 2 sets of 2 independent reviewers using a standardized data-collection form. Disagreements were resolved by a third reviewer. Authors were contacted to obtain any missing data. DATA SYNTHESIS Our search identified 691 studies, of which 30 met criteria for inclusion in the analysis. Implementation of an RRT/MET was associated with a significant decrease in hospital mortality (relative risk [RR] = 0.88, 95% confidence interval [CI]: 0.83-0.93, I(2) = 86%, 3,478,952 admissions) and a significant decrease in the number of non-ICU cardiac arrests (RR = 0.62, 95% CI: 0.55-0.69, I(2) = 71%, 3,045,273 admissions). CONCLUSIONS Implementation of an RRT/MET is associated with a reduction in both hospital mortality and non-ICU cardiopulmonary arrests. Journal of Hospital Medicine 2016;11:438-445. © 2016 Society of Hospital Medicine.

[1]  Patricia Kipnis,et al.  Early detection of impending physiologic deterioration among patients who are not in intensive care: development of predictive models using data from an automated electronic medical record. , 2012, Journal of hospital medicine.

[2]  H. Park,et al.  Early impact of medical emergency team implementation in a country with limited medical resources: a before-and-after study. , 2011, Journal of critical care.

[3]  Amy Boyer,et al.  The effect of a rapid response team on major clinical outcome measures in a community hospital* , 2007, Critical care medicine.

[4]  D. King,et al.  Implementing a rapid response team to decrease emergencies outside the ICU: one hospital's experience. , 2009, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

[5]  Geoffrey K Lighthall,et al.  Abnormal vital signs are associated with an increased risk for critical events in US veteran inpatients. , 2009, Resuscitation.

[6]  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.

[7]  John A Spertus,et al.  Hospital-wide code rates and mortality before and after implementation of a rapid response team. , 2008, JAMA.

[8]  Sallie J. Weaver,et al.  Rapid-Response Systems as a Patient Safety Strategy , 2013, Annals of Internal Medicine.

[9]  K. Hillman,et al.  Duration of life-threatening antecedents prior to intensive care admission , 2002, Intensive Care Medicine.

[10]  M. J. Hall,et al.  Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000-2010. , 2013, NCHS data brief.

[11]  J. Santamaria,et al.  Changing cardiac arrest and hospital mortality rates through a medical emergency team takes time and constant review* , 2010, Critical Care Medicine.

[12]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

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

[14]  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.

[15]  P. K. Yokota,et al.  Reduced frequency of cardiopulmonary arrests by rapid response teams. , 2012, Einstein.

[16]  S. Roman,et al.  Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009. , 2013, Resuscitation.

[17]  N. Gibran,et al.  Rapid Response Team Implementation on a Burn Surgery/Acute Care Ward , 2014, Journal of burn care & research : official publication of the American Burn Association.

[18]  Susan J. McFarlan,et al.  Implementation and Outcomes of a Rapid Response Team , 2007, Journal of nursing care quality.

[19]  M. K. Bader,et al.  Rescue me: saving the vulnerable non-ICU patient population. , 2009, Joint Commission journal on quality and patient safety.

[20]  T. Hodgetts,et al.  Evaluation of a medical emergency team one year after implementation. , 2004, Resuscitation.

[21]  T. Wagner,et al.  Introduction of a Rapid Response System at a United States Veterans Affairs Hospital Reduced Cardiac Arrests , 2010, Anesthesia and analgesia.

[22]  Daryl A Jones,et al.  Long-term effect of a Medical Emergency Team on mortality in a teaching hospital. , 2007, Resuscitation.

[23]  Yvette Bertaut,et al.  Implementing a rapid-response team using a nurse-to-nurse consult approach. , 2008, Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing.

[24]  Daryl A Jones,et al.  Long term effect of a medical emergency team on cardiac arrests in a teaching hospital , 2005, Critical care.

[25]  K. Hillman,et al.  The impact of implementing a rapid response system: a comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia. , 2014, Resuscitation.

[26]  Chenyang Lu,et al.  A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team. , 2014, Journal of hospital medicine.

[27]  C. Karpman,et al.  The Impact of Rapid Response Team on Outcome of Patients Transferred From the Ward to the ICU: A Single-Center Study* , 2013, Critical care medicine.

[28]  Tien Chey,et al.  Rates of in‐hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team , 2000, The Medical journal of Australia.

[29]  G. Gravlee.  Rapid Response Team in an Academic Institution: Does It Make a Difference? , 2012 .

[30]  D. Berwick,et al.  The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. , 2006, JAMA.

[31]  Hasan M. Al-Dorzi,et al.  Impact of an Intensivist-Led Multidisciplinary Extended Rapid Response Team on Hospital-Wide Cardiopulmonary Arrests and Mortality* , 2013, Critical care medicine.

[32]  J. Tibballs,et al.  A prospective before‐and‐after trial of a medical emergency team , 2004, The Medical journal of Australia.

[33]  P. Offner,et al.  Implementation of a rapid response team decreases cardiac arrest outside of the intensive care unit. , 2007, The Journal of trauma.

[34]  Comilla Sasson,et al.  Rapid Response Teams: A Systematic Review and Meta-analysis. , 2010, Archives of internal medicine.

[35]  Vincent Liu,et al.  Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. , 2012, Journal of hospital medicine.

[36]  L. Leach,et al.  Improving Patient Safety to Reduce Preventable Deaths: The Case of a California Safety Net Hospital , 2012, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[37]  Arash Rashidian,et al.  Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital , 2004, Intensive Care Medicine.

[38]  H. Friedman,et al.  Effect of a rapid response team on patient outcomes in a community-based teaching hospital. , 2014, Journal of graduate medical education.

[39]  K. Shojania,et al.  The tension between needing to improve care and knowing how to do it. , 2007, The New England journal of medicine.

[40]  Michael B. Rothberg,et al.  Four years' experience with a hospitalist-led medical emergency team: an interrupted time series. , 2012, Journal of hospital medicine.

[41]  C. Corbett,et al.  Rapid Response Team Implementation and In-Hospital Mortality* , 2014, Critical care medicine.

[42]  F. Granath,et al.  Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team , 2009, Intensive Care Medicine.

[43]  David H. Chong,et al.  Reduction in hospital-wide mortality after term cohort study , 2011 .