Saving Patients’ Lives Through Activating a Rapid Response System

Abstract

Commission, it has gained wide acceptance and has been implemented across many hospitals. However, despite the clear clinical intuition underlying the RRS concept and its popularity, several studies have failed to show a significant improvement in patient outcomes, in particular, in reduced patient mortality (2). Such results have led to controversy regarding its effectiveness. The RRS concept is a hospital-wide intervention with the intention and promise to save patient lives. However, among the 10 patient safety strategy systematic reviews commissioned by the Agency for Healthcare Research and Quality (3), the RRS, as a patient safety strategy, was not recommended or included in the list of "Strongly encouraged" strategies but only included in the list of "Encouraged" (4). This is despite strong evidence supporting its possible dose-response effect (more rapid response team [RRT] calls and lower hospital mortality) in the largest study ever conducted in this field (5) (i.e., a 23-hospital cluster randomized controlled trial) as well as the long raised issue of how the evidence related to complex system intervention in patient safety should be assessed and policy recommendations made (6).In this light, in a recent issue of Critical Care Medicine, the study by Barwise et al (7), which found a significant relationship between delayed RRT activation and increased hospital mortality and morbidity as well as increased length of stay in a tertiary care hospital, is important in helping our understanding of the effectiveness and implementation of a RRS: 1) these findings are consistent with other similar studies (8-12) that all showed a significant relationship between delayed calls and increased hospital mortality (it was estimated that every 100 delayed calls were associated with an extra 13 deaths by a multicenter study) (12); 2) the consistency and robustness of such findings across different studies conducted at different settings provided pivotal evidence that nondelayed RRT activation could save more patient lives and support the notion that a RRS actually can save patient lives; 3) the rate of delayed calls in the current study is high (57%, in comparison with 29% reported in a large multicenter study which was based on a more relaxed delay call definition [> 15 min given the exist calling criteria (12) compared with the current study of using > 1 hr as the cutoff]); 4) the substantial proportion of delayed calls highlighted that despite the promises, much more could be done to improve the compliance of RRTs and RRSs to save patient lives; 5) the study included a large number of RRT calls (1,227) in 2012 in an institution with an RRS since 2007. It is especially important to recognize that delayed calls to a RRT not only occurred in a hospital with a newly implemented RRS. Even for a mature RRS hospital, such a problem can be substantial and can persist; 6) the results reinforce the concept that not only failing to call (5) but also failing to call early can be fatal and defeats the purpose of a RRS.The authors...

Impact of nighttime Rapid Response Team activation on outcomes of hospitalized patients with acute deterioration

“…Importantly, we found that nighttime RRT activation was associated with prolonged latency from the onset of concerning symptoms and signs. Delays in RRT activation have been shown to be associated with worse outcomes [ 35 , 36 ]. These increased delays may occur because of impaired recognition and/or monitoring of clinical deterioration.…”

Prevalence, Risk Factors, and Clinical Consequences of Recurrent Activation of a Rapid Response Team: A Multicenter Observational Study

“…Delays in RRT activation have been shown to be associated with worse outcomes. 25,26 It is unclear why these delays occurred. It may be that these patients were less ill appearing or frail (a higher proportion were initially from home, as opposed to a long-term care facility), and therefore, there was delay to activation of the RRT.…”