Advanced practice providers versus medical residents as leaders of rapid response teams: A 12-month retrospective analysis

Abstract

Purpose In a time of worldwide physician shortages, the advanced practice providers (APPs) might be a good alternative for physicians as the leaders of a rapid response team. This retrospective analysis aimed to establish whether the performance of APP-led rapid response teams is comparable to the performance of rapid response teams led by a medical resident of the ICU. Material and methods In a retrospective single-center cohort study, the electronic medical record of a tertiary hospital was queried during a 12-months period to identify patients who had been visited by our rapid response team. Patient- and process-related outcomes of interventions of rapid response teams led by an APP were compared with those of teams led by a medical resident using various parameters, including the MAELOR tool, which measures the performance of a rapid response team. Results In total, 179 responses of the APP-led teams were analyzed, versus 275 responses of the teams led by a resident. Per APP, twice as many calls were handled than per resident. Interventions of teams led by APPs, and residents did not differ in number of admissions (p = 0.87), mortality (p = 0.8), early warning scores (p = 0.2) or MAELOR tool triggering (p = 0.19). Both groups scored equally on time to admission (p = 0.67) or time until any performed intervention. Conclusion This retrospective analysis showed that the quality of APP-led rapid response teams was similar to the quality of teams led by a resident. These findings need to be confirmed by prospective studies with balanced outcome parameters.

Advanced Practice Providers as Leaders of a Rapid Response Team: A Prospective Cohort Study

“…Although several studies have been performed to assess differences in the level of technical and non-technical skills of APPs, it remains difficult to establish the specific individual contribution of an APP’s performance to the combined outcome of a complex multidisciplinary process of care. Previous studies suggested that this topic should be analyzed in prospective studies using more sophisticated statistical methods [ 18 , 19 ].…”

Educational Interventions for Rapid Response Team Members

“…Professional roles included in these studies varied widely but commonly included physicians, advanced practice providers, critical care nurses, and respiratory therapists. [9][10][11] The composition of RRTs in practice varies widely, and more research is needed to understand what is the optimal team composition, which will assist with achieving consistent patient outcomes. 12 Another component of rapid response systems and part of the afferent limb that has been studied are early warning systems.…”

“…Multiple studies have addressed the areas of team composition of RRTs (efferent limb) including studies that examined different models of not only who was included but also who took lead. Professional roles included in these studies varied widely but commonly included physicians, advanced practice providers, critical care nurses, and respiratory therapists 9-11 . The composition of RRTs in practice varies widely, and more research is needed to understand what is the optimal team composition, which will assist with achieving consistent patient outcomes 12 …”