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Published on: February 19, 2021
Evaluating implementation of a rapid response team: considering alternative outcome measures
James P Moriarty1, Nicola E Schiebel, Matthew G Johnson
1Health Care Policy and Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. naessens@mayo.edu.
Objective:
Determine the prolonged effect of rapid response team (RRT) implementation on failure to rescue (FTR).
Design:
Longitudinal study of institutional performance with control charts and Bayesian change point (BCP) analysis.
Setting:
Two academic hospitals in Midwest, USA.
Participants:
All inpatients discharged between 1 September 2005 and 31 December 2010.
Intervention:
Implementation of an RRT serving the Mayo Clinic Rochester system was phased in for all inpatient services beginning in September 2006 and was completed in February 2008.
Main Outcome Measure:
Modified version of the AHRQ FTR measure, which identifies hospital mortalities among medical and surgical patients with specified in-hospital complications.
Results:
A decrease in FTR, as well as an increase in the unplanned ICU transfer rate, occurred in the second-year post-RRT implementation coinciding with an increase in RRT calls per month. No significant decreases were observed pre- and post-implementation for cardiopulmonary resuscitation events or overall mortality. A significant decrease in mortality among non-ICU discharges was identified by control charts, although this finding was not detected by BCP or pre- vs. post-analyses.
Conclusions:
Reduction in the FTR rate was associated with a substantial increase in the number of RRT calls. Effects of RRT may not be seen until RRT calls reach a sufficient threshold. FTR rate may be better at capturing the effect of RRT implementation than the rate of cardiac arrests. These results support prior reports that short-term studies may underestimate the impact of RRT systems, and support the need for ongoing monitoring and assessment of outcomes to facilitate best resource utilization.
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