Resuscitation
Volume 81, Issue 1 , Pages 31-35, January 2010

The impact of Rapid Response System on delayed emergency team activation patient characteristics and outcomes—A follow-up study☆

  • Paolo Calzavacca

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • ,
  • Elisa Licari

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • ,
  • Augustine Tee

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • ,
  • Moritoki Egi

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • ,
  • Andrew Downey

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • ,
  • Jon Quach

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • ,
  • Anja Haase-Fielitz

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • Department of Nephrology and Intensive Care, Charité University Hospital, Berlin, Germany
    • ,
  • Michael Haase

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • Department of Nephrology and Intensive Care, Charité University Hospital, Berlin, Germany
    • ,
  • Rinaldo Bellomo

      Affiliations

    • Department of Intensive Care, Austin Hospital, Melbourne, Australia
    • Department of Medicine, Austin Hospital, Melbourne, Australia
    • Corresponding Author InformationCorresponding author at: Department of Intensive Care, Austin Hospital, Studley Rd, Heidelberg, Victoria 3084, Australia. Tel.: +61 3 9496 5992; fax: +61 3 9496 3932.

Received 12 July 2009; received in revised form 15 September 2009; accepted 22 September 2009. published online 26 October 2009.

Abstract 

Objective

To evaluate the impact of Rapid Response System (RRS) maturation on delayed Medical Emergency Team (MET) activation and patient characteristics and outcomes.

Design

Observational study.

Setting

Tertiary hospital.

Patients

Recent cohort of 200 patients receiving a MET review and early control cohort of 400 patients receiving a MET review five years earlier at the start of RRS implementation.

Measurements and results

We obtained information including demographics, clinical triggers for and timing of MET activation in relation to the first documented MET review criterion (activation delay) and patient outcomes. We found that patients in the recent cohort were older, more likely to be surgical and to have Not For Resuscitation (NFR) orders before MET review. Furthermore, fewer patients (22.0% vs. 40.3%, p<0.001) had delayed MET activation. When delayed activation occurred, there was a non-significant difference in its duration (early cohort: 12.0 [IQR 23.0]h vs. recent cohort: 9.0 [IQR 20.5]h, p=0.554). Similarly, unplanned ICU admissions decreased from 31.3% to 17.3% (p<0.001). Delayed MET activation was independently associated with greater risk of unplanned ICU admission and hospital mortality (O.R. 1.79, 95% C.I. 1.33.–2.93, p=0.003 and O.R. 2.18, 95% C.I. 1.42–3.33, p<0.001, respectively). Being part of the recent cohort was independently associated with a decreased risk of delayed activation (O.R. 0.45, 95% C.I. 0.30–0.67, p<0.001) and unplanned ICU admission (O.R. 0.5, 95% C.I. 0.32–0.78, p=0.003).

Conclusions

Maturation of a RRS is associated with a decrease in the incidence of unplanned ICU admissions and MET activation delay. Assessment of a RRS early in the course of its implementation may underestimate its efficacy.

Keywords: Medical Emergency Team, Rapid Response System, Critical illness, Vital signs, Mortality, Not For Resuscitation orders, Delayed intervention, Outcome, Hospital

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☆ A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.09.026.

PII: S0300-9572(09)00502-4

doi:10.1016/j.resuscitation.2009.09.026

Resuscitation
Volume 81, Issue 1 , Pages 31-35, January 2010

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