Impact of a critical care outreach team on critical care readmissions and mortality

Garcea, Giuseppe; Thomasset, Sarah; McClelland, Laura E.; Leslie, A.; Berry, D

doi:10.1111/j.1399-6576.2004.00509.x

Cited by 72 publications

(52 citation statements)

References 16 publications

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“…One study published in abstract form 39 used the rapid response team model, consisting of a critical care nurse and a respiratory therapist, with assistance as needed from the primary medical staff and a critical care physician. Three studies 3,24,35 from UK hospitals used the critical care outreach (CCO) model, in which ICU-trained nurses respond initially with assistance from intensivists. The CCO model also involves follow-up on patients discharged from the ICU and proactive rounding on unstable ward patients.…”

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

“…All other trials included were before-after studies with no contemporaneous control group Most studies did not meet criteria for internal validity or generalizability (Table 2). Two studies 3,35 did not report the number of RRS calls during the study period. One study 22 omitted patients whose resuscitation status was changed after RRS evaluation from the calculation of inpatient mortality; thus, the patients who had been made "do not resuscitate" by the RRS did not contribute to the calculated mortality rate.…”

Section: Figurementioning

confidence: 99%

“…Nine studies 3,22,23,33,[35][36][37]39,40 reported the effect of an RRS on inpatient mortality, 9 studies 22,23,31,33,34,[36][37][38]40 reported its effect on cardiopulmonary arrests, and 6 studies 3,22,24,33,36,37 reported its effect on unscheduled ICU admissions. Of these, 7 trials that reported mortality and cardiopulmonary arrests and 6 studies that reported unscheduled ICU admissions supplied sufficient data for meta-analysis.…”

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

“…As shown in Figures 1 and 2, the MERIT trial intervention and control groups were treated as separate before-after trials. The study by Garcea et al 3 evaluated the effect of RRS on readmissions to ICU. The supplied outcomes are for unscheduled readmissions to ICU; thus, the baseline unscheduled ICU admission rate is not reported.…”

Section: Figure 3 Effect Of Rrs On Cardiopulmonary Arrestsmentioning

confidence: 99%

“…Equivalent terms used are rapid response team, 2 critical care outreach team, 3 and patient-at-risk team. 4 A consensus panel 5 recently endorsed use of the term rapid response system (RRS) to denote any system that uses a standard set of clinical criteria to summon caregivers to the bedside of a patient who is deemed unstable but not in cardiopulmonary arrest (in which case a standard resuscitation team would be summoned).…”

mentioning

confidence: 99%

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Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

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BACKGROUNDA rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster‐randomized trial.PURPOSETo evaluate the effects of RRSs on clinical outcomes through a systematic literature review.DATA SOURCESMEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies.STUDY SELECTIONRandomized and nonrandomized controlled trials, interrupted time series, and before‐after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions.DATA EXTRACTIONTwo authors independently determined study eligibility, abstracted data, and classified study quality.DATA SYNTHESISThirteen studies met inclusion criteria: 1 cluster‐randomized controlled trial (RCT), 1 interrupted time series, and 11 before‐after studies. The RCT showed no effects on any clinical outcome. Before‐after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74‐0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65‐0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before‐after studies.CONCLUSIONSPublished studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before‐after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422–432. © 2007 Society of Hospital Medicine.

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Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

Section: Figure 3 Effect Of Rrs On Cardiopulmonary Arrestsmentioning

confidence: 99%

mentioning

confidence: 99%

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Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

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Defining the Incidence of Cardiorespiratory Instability in Patients in Step-down Units Using an Electronic Integrated Monitoring System

Hravnak¹

2008

Arch Intern Med

113

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Background: To our knowledge, detection of cardiorespiratory instability using noninvasive monitoring via electronic integrated monitoring systems (IMSs) in intermediate or step-down units (SDUs) has not been described. We undertook this study to characterize respiratory status in an SDU population, to define features of cardiorespiratory instability, and to evaluate an IMS index value that should trigger medical emergency team (MET) activation.Methods: This descriptive, prospective, singleblinded, observational study evaluated all patients in a 24-bed SDU in a university medical center during 8 weeks from November 16, 2006, to January 11, 2007. An IMS (BioSign; OBS Medical, Carmel, Indiana) was inserted into the standard noninvasive hardwired monitoring system and used heart rate, blood pressure, respiratory rate, and peripheral oxygen saturation by pulse oximetry to develop a single neural networked signal, or BioSign Index (BSI). Data were analyzed for cardiorespiratory instability according to BSI trigger value and local MET activation criteria. Staff were blinded to BSI data collected in 326 patients (total census).Results: Data for 18 248 hours of continuous monitoring were captured. Data for peripheral oxygen saturation by pulse oximetry were absent in 30% of monitored hours despite being a standard of care. Cardiorespiratory status in most patients (243 of 326 [74.5%]) was stable throughout their SDU stay, and instability in the remaining patients (83 of 326 [25%]) was exhibited infrequently. We recorded 111 MET activation criteria events caused by cardiorespiratory instability in 59 patients, but MET activation for this cause occurred in only 7 patients. All MET events were detected by BSI in advance (mean, 6.3 hours) in a bimodal distribution (Ͼ6 hours and Յ45 minutes).Conclusions: Cardiorespiratory instability, while uncommon and often unrecognized, was preceded by elevation of the IMS index. Continuous noninvasive monitoring augmented by IMS provides sensitive detection of early instability in patients in SDUs.

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Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of critically ill adult patients on general hospital wards

McGaughey

Alderdice

Fowler

et al. 2007

Cochrane Database of Systematic Reviews

184

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Impact of a critical care outreach team on critical care readmissions and mortality

Abstract: There are many confounding factors in assessing the impact of outreach teams in hospitals. This study tentatively concludes that outreach teams may have a favourable impact on mortality rate amongst readmissions to critical care, but more data is needed from multicentre trials.

Cited by 72 publications

References 16 publications

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Defining the Incidence of Cardiorespiratory Instability in Patients in Step-down Units Using an Electronic Integrated Monitoring System

Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of critically ill adult patients on general hospital wards

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