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The impact of implementing a rapid response system: A comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia

  • Jack Chen
    Correspondence
    Corresponding author at: Level 1, AGSM Building, Simpson Centre for Health Services Research, Australian Institute of Health Innovation, University of New South Wales, Australia.
    Affiliations
    Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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  • Lixin Ou
    Affiliations
    Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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  • Ken Hillman
    Affiliations
    Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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  • Arthas Flabouris
    Affiliations
    Intensive Care Unit, Royal Adelaide Hospital and School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
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  • Rinaldo Bellomo
    Affiliations
    Intensive Care Unit, Austin Medical Centre, Melbourne, Victoria, Australia
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  • Stephanie J. Hollis
    Affiliations
    Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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  • Hassan Assareh
    Affiliations
    Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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      Abstract

      Aims

      To compare clinical outcomes between a teaching hospital with a mature rapid response system (RRS), with three similar teaching hospitals without a RRS in Sydney, Australia.

      Methods

      For the period 2002–2009, we compared a teaching hospital with a mature RRS, with three similar teaching hospitals without a RRS. Two non-RRS hospitals began implementing the system in 2009 and a third in January 2010. We compared the rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality, overall hospital mortality and 1-year post discharge mortality after IHCA between the RRS hospital and the non-RRS hospitals based on three separate analyses: (1) pooled analysis during 2002–2008; (2) before–after difference between 2008 and 2009; (3) after implementation in 2009.

      Results

      During the 2002–2008 period, the mature RRS hospital had a greater than 50% lower IHCA rate, a 40% lower IHCA-related mortality, and 6% lower overall hospital mortality. Compared to 2008, in their first year of RRS (2009) two hospitals achieved a 22% reduction in IHCA rate, a 22% reduction in IHCA-related mortality and an 11% reduction in overall hospital mortality. During the same time, the mature RRS hospital showed no significant change in those outcomes but, in 2009, it still achieved a crude 20% lower IHCA rate, and a 14% lower overall hospital mortality rate. There was no significant difference in 1-year post-discharge mortality for survivors of IHCA over the study period.

      Conclusions

      Implementation of a RRS was associated with a significant reduction in IHCA, IHCA-related mortality and overall hospital mortality.

      Keywords

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