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.