Hospital-wide Code Rates and Mortality Before and After Implementation of a Rapid Response Team

Context Rapid response teams have been shown in adult inpatients to decrease cardiopulmonary arrest ( code) rates outside of the intensive care unit ( ICU). Because a primary action of rapid response teams is to transfer patients to the ICU, their ability to reduce hospital- wide code rates and mortality remains unknown. Objective To determine rates of hospital- wide codes and mortality before and after implementation of a long- term rapid response team intervention. Design, Setting, and Patients A prospective cohort design of adult inpatients admitted between January 1, 2004, and August 31, 2007, at Saint Luke's Hospital, a 404- bed tertiary care academic hospital in Kansas City, Missouri. Rapid response team education and program rollout occurred from September 1 to December 31, 2005. A total of 24 193 patient admissions were evaluated prior to the intervention ( January 1, 2004, to August 31, 2005), and 24 978 admissions were evaluated after the intervention ( January 1, 2006, to August 31, 2007). Intervention Using standard activation criteria, a 3- member rapid response team composed of experienced ICU staff and a respiratory therapist performed the evaluation, treatment, and triage of inpatients with evidence of acute physiological decline. Main Outcome Measures Hospital- wide code rates and mortality, adjusted for preintervention trends. Results There were a total of 376 rapid response team activations. After rapid response team implementation, mean hospital- wide code rates decreased from 11.2 to 7.5 per 1000 admissions. This was not associated with a reduction in the primary end point of hospital- wide code rates ( adjusted odds ratio [ AOR], 0.76 [ 95% confidence interval {CI}, 0.57- 1.01]; P=. 06), although lower rates of non- ICU codes were observed ( non- ICU AOR, 0.59 [ 95% CI, 0.40- 0.89] vs ICU AOR, 0.95 [ 95% CI, 0.641.43]; P=. 03 for interaction). Similarly, hospital- wide mortality did not differ between the preintervention and postintervention periods ( 3.22 vs 3.09 per 100 admissions; AOR, 0.95 [ 95% CI, 0.81- 1.11]; P=. 52). Secondary analyses revealed few instances of rapid response team undertreatment or underuse that may have affected the mortality findings. Conclusion In this large single- institution study, rapid response team implementation was not associated with reductions in hospital- wide code rates or mortality.