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Rapid Response Team Implementation on a Burn Surgery/Acute Care Ward

Moroseos, Teresa BS*; Bidwell, Karen ARNP*; Rui, Lin MHA; Fuhrman, Lawrence; Gibran, Nicole S. MD*; Honari, Shari RN, BSN*; Pham, Tam N. MD*

doi: 10.1097/BCR.0b013e3182a2acae
2013 Clinical Research Award

To date there is limited evidence of efficacy for rapid response teams (RRT) in burns despite widespread their implementation in U.S. hospitals. The burn surgery/acute care ward at the Harborview Medical Center, Seattle, Washington, primarily treats burns, acute wounds, and pediatric trauma patients, but also accepts overflow surgical and medical patients. The authors hypothesize that institutional RRT implementation in 2006 has reduced code blue activations, unplanned intensive care unit (ICU) transfers, and mortality on the acute care ward of this hospital. The authors retrospectively analyzed all patients treated in our acute care unit before (2000–2004) and after RRT implementation (2007–2011). Patient, injury, and treatment outcomes information were collected and analyzed. The authors specifically examined clinical signs that triggered RRT activation and processes of care after activation. They compared code blue activation rates, unplanned ICU transfers, and mortality between the two periods by Poisson regression. The acute care unit treated 7092 patients before and 9357 patients after RRT implementation. There were 409 RRT activations in 329 patients, 18 of whom ultimately died during hospitalization. Those who died had higher rates of stridor (P = .03), tachypnea (P = .001), and low oxygen saturations (P = .02) compared with survivors. Fewer burn and surgical patients died after implementation (seven patients; 22% of all deaths) compared with patients who died pre-RRT (27 patients; 53% of all deaths). After adjustment for case-mix index, age, and medical service differences between the two periods, code blue calls decreased from 1.4/1000 to 0.4/1000 admissions (P = .04), unplanned ICU transfer rates decreased from 65/1000 to 50/1000 admissions (P < .01), and hospital deaths decreased from 4.5/1000 to 3.3/1000 admissions (P = .11). Since its implementation, RRT activation has been frequently used in the acute care ward of this hospital. Respiratory symptoms distinguish RRT patients who die during hospitalization compared with survivors. RRT implementation was associated with fewer code blue activations, unplanned ICU transfers, and a trend toward reduced in-hospital deaths, particularly in burn and surgical patients.

From the *Department of Surgery, University of Washington Regional Burn Center, and University of Washington Medicine Finance, Decision Support, University of Washington, Seattle.

Address correspondence to Teresa Moroseos, BS, Department of Surgery, UW Regional Burn Center, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359796, Seattle, Washington 98104.

© 2014 The American Burn Association