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Impact of an Intensivist-Led Multidisciplinary Extended Rapid Response Team on Hospital-Wide Cardiopulmonary Arrests and Mortality*

Al-Qahtani, Saad MD, FRCPC1; Al-Dorzi, Hasan M. MD1; Tamim, Hani M. MPH, PhD2; Hussain, Sajid MBBS1; Fong, Lian RN1; Taher, Saadi MBChB, FRCP3; Al-Knawy, Bandar Abdulmohsen MD, FRCP(C)4; Arabi, Yaseen MD, FCCP, FCCM1

doi: 10.1097/CCM.0b013e318271440b
Clinical Investigations

Objective: The effectiveness of rapid response teams remains controversial. However, many studied rapid response teams were not intensivist-led, had limited involvement beyond the initial activations, and did not provide post-ICU follow-up. The objective of this study was to examine the impact of implementing an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality.

Design: This was a pre-post rapid response team implementation study.

Setting: Tertiary care academic center in Saudi Arabia.

Patients: A total of 98,391 patients in the 2-yr pre-rapid response team and 157,804 patients in the 3-yr post-rapid response team implementation were evaluated.

Intervention: The rapid response team was activated by any health care provider based on pre-defined criteria and a four-member intensivist-led multidisciplinary rapid response team responded to provide the necessary management and disposition. The rapid response team function was extended to provide follow-up until clinical stabilization. In addition, the rapid response team provided a mandatory post-ICU follow-up for a minimum of 48 hrs.

Measurements and Main Results: The primary outcomes were cardiopulmonary arrests and mortality. After rapid response team implementation, non-ICU cardiopulmonary arrests decreased from 1.4 to 0.9 per 1,000 hospital admissions (relative risk, 0.68; 95% confidence interval, 0.53–0.86; p = 0.001) and total hospital mortality decreased from 22.5 to 20.2 per 1,000 hospital admissions (relative risk, 0.90; 95% confidence interval, 0.85–0.95; p < 0.0001). For patients who required admission to the ICU, there was a significant reduction in the Acute Physiology and Chronic Health Evaluation II scores after rapid response team implementation from 29.3 ± 9.3 to 26.9 ± 8.5 (p < 0.0001), with reduction in hospital mortality from 57.4% to 48.7% (relative risk, 0.85; 95% confidence interval, 0.78–0.92; p < 0.0001). Do-not-resuscitate orders for ward referrals increased from 0.7 to 1.7 per 1,000 hospital admissions (relative risk, 2.58; 95% confidence interval, 1.95–3.42; p < 0.0001) and decreased for patients admitted to ICU from the wards from 30.5% to 26.1% (relative risk, 0.86; 95% confidence interval, 0.74–0.99; p = 0.03). Additionally, ICU readmission rate decreased from 18.6 to 14.3 per 100 ICU alive discharges (relative risk, 0.77; 95% confidence interval, 0.66–0.89; p < 0.0001) and post-ICU hospital mortality from 18.2% to 14.8% (relative risk, 0.85; 95% confidence interval, 0.72–0.99; p = 0.04).

Conclusion: The implementation of rapid response team was effective in reducing cardiopulmonary arrests and total hospital mortality for ward patients, improving the outcomes of patients who needed ICU admission and reduced readmissions and mortality of patients who were discharged from the ICU.

1 Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

2 Department of Epidemiology and Biostatistics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

3 Medical Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

4 Health Affairs, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

*See also p. 679.

All the authors helped in conception and design, analysis and interpretation of data, drafting of the manuscript; Drs Al-Qahtani, Taher, Al-Knawy, and Arabi helped with administrative, technical, and material support; Dr. Al-Qahtani, Ms. Fong, Dr. Taher, Dr. Al-Knawy, and Dr. Arabi helped with supervision; Drs. Al-Dorzi, Tamim, Taher, Al-Knawy, and Arabi helped with critical revision of the manuscript for important intellectual content; Dr. Tamim helped with statistical analysis; Dr. Hussain and Ms. Fong helped with acquisition of data; Dr. Arabi had full access to all of the data in the study and takes responsibility for the integrity and the accuracy of the data analysis.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: yaseenarabi@yahoo.com; icu1@ngha.med.sa

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins