Abstract 502: Long-Term Effects of a Rapid Response Team on Hospital-Wide Code Rates and Mortality
Background: Rapid response teams (RRTs) have been shown to decrease cardiopulmonary arrest (code) rates outside of the intensive care unit (ICU). Because a primary action of RRTs is to transfer patients to the ICU, their impact on hospital-wide code rates and mortality remains poorly understood.
Methods: Data on RRT activations and codes were prospectively collected at a 404-bed tertiary care academic hospital. RRT education and program rollout occurred from September to December, 2005. A total of 24,193 patient admissions were evaluated pre-intervention (January 2004 to August 2005), and 24,978 admissions were evaluated post-intervention (January 2006 to August 2007). Main outcome measures were hospital-wide code rates and mortality; these were compared between the pre- and post-intervention periods using multivariable regression models that adjusted for pre-intervention trends and differences in demographics and hospital case mix.
Results: After RRT implementation, mean hospital-wide code rates decreased from 11.2 to 7.5 per 1000 admissions. This was associated with a trend toward lower code rates (Odds Ratio [OR]=0.76; 95% CI: 0.57 to 1.01; p=0.06) and was mediated through lower rates of non-ICU codes (non-ICU: OR=0.59; 95% CI: 0.40 – 0.89 vs. ICU: OR=0.95; 95% CI: 0.64–1.43; p-value for interaction of 0.03). The effect of RRTs on code rates was similar for codes due to respiratory arrests, shockable cardiac arrests (ventricular fibrillation and pulseless ventricular tachycardia), and non-shockable cardiac arrests (pulseless electrical activity and asystole) (p-value for interaction of 0.42). However, hospital-wide mortality did not differ between the pre- and post-intervention periods (3.22 vs. 3.09 per 100 admissions; OR=0.95; 95% CI: 0.81 to 1.11; p=0.52). Post-hoc analyses revealed 18 instances of RRT under-treatment or underutilization that would not have significantly affected the mortality findings had these deaths been avoided (OR of 0.93; 95% CI: 0.79 to 1.09; p=0.35).
Conclusions: RRT implementation was associated with a strong trend toward lower hospital-wide code rates, especially in non-ICU settings. However, further studies are required to demonstrate a mortality benefit before RRTs become the standard of care.