Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals

Abstract

Objectives: Despite improvements in the management of in-hospital cardiac arrest over the past decade, in-hospital cardiac arrest continues to be associated with poor prognosis. This has led to the development of rapid response systems, hospital-wide efforts to improve patient outcomes by centering on prompt identification of decompensating patients, expert clinical management, and continuous quality improvement of processes of care. The rapid response system may include cardiac arrest teams, which are centered on identification and treatment of patients with in-hospital cardiac arrest. However, few evidence-based guidelines exist to guide the formation of such teams, and the degree of their variation across the United States has not been well described. Design: Descriptive cross-sectional, internet-based survey. Setting: Cohort of preidentified clinicians involved in their hospital’s adult rapid response system across the United States. Subjects: Clinicians who had been identified by study team members using personal and professional contacts over a 7-month period from June 2018 to December 2018. Interventions: An 80-item survey was developed by the investigators. It sought information on the afferent (identification and notification of providers) and efferent (response of providers to patient) limbs of the rapid response system, as well as management of patients post in-hospital cardiac arrest. Measurements and Main Results: One-hundred fourteen surveys were distributed. Of these, 109 (96%) were completed. Six were duplicates and were excluded, leaving a total of 103 surveys from 103 hospitals in 30 states. Seventy-six percent of hospitals were academic, 30% were large hospitals (> 750 inpatient beds), and 58% had large ICUs (> 50 ICU beds). We found wide variation in the structure and function in both the afferent and efferent limbs of the rapid response system. The majority of hospitals had a rapid response team and a cardiac arrest team. Most rapid response teams contained a provider, a critical care nurse, and a respiratory therapist. In hospitals with training programs in internal medicine, anesthesia, emergency medicine, or critical care, 45% of rapid response teams and 75% of cardiac arrest teams were led by trainees, with inconsistent attending presence. Targeted temperature management and coronary catheterization were widely used post in-hospital cardiac arrest, but indications varied considerably. Conclusions: We have demonstrated substantial variation in the structure and function of rapid response systems as well as in management of patients during and after in-hospital cardiac arrest.

Construct and clinical verification of a nurse-led rapid response systems and activation criteria

“…Jones et al confirmed that the RRT reduces the rate of cardiac arrest and reported that one cardiac arrest could be prevented in every 17 by RRT [ 29 ]. The study found the rate of cardiac arrest decreased from 72.62 to 39.01%, which consistent with others [ 14 , 22 , 23 , 27 , 28 ]. These findings may be related to the activation criteria that can be monitored in real time, which can guide callers in identifying high-risk patients early and activate the nurse-led RRS for intervention.…”

“…Sudden cardiac arrest is a rapidly progressing event that affects millions of people every year. It is estimated that tens of thousands of people die from cardiac arrest every year, accounting for 15 to 20% of all deaths worldwide [ 22 , 23 ]. However, only a very few patients can be successfully rescued.…”

Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study

“…Despite its widespread adoption, rapid response systems (RRS) and rapid response teams (RRT) vary significantly in composition and set-up. [1][2][3] While implementation of RRSs appear to be associated with reduced cardiac arrest rate and improved mortality, 4,5 their optimal composition, activation criteria and how they should be evaluated, remain controversial. [6][7][8][9] It is likely that RRS staffing, calling criteria and clinical pathways are influenced by the available expertise, patient case-mix and resources in each hospital.…”

Rapid response system adaptations at 40 US hospitals during the COVID-19 pandemic

“…This is especially pertinent given the wide variation in emergency team structure in the United States. 12 The second round of the survey also had a lower response rate than the first, which may further impact the generalizability of our findings. Additionally, we only captured adaptations that had been made at the time of the initial survey, which took place during the initial wave of COVID-19 in the United States and not subsequent adaptations to team structure or function.…”