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  4. Authors Evaluate Effects of a Rapid-Response Team on Mortality and Code Rates at a Children's Hospital

Authors Evaluate Effects of a Rapid-Response Team on Mortality and Code Rates at a Children's Hospital

December 10, 2007

"Implementation of an RRT [rapid-response team] in our free-standing, quaternary care academic children's hospital was associated with statistically significant reductions in hospital-wide mortality rates and code rates outside the ICU [intensive care unit] setting," state the authors of an article published in the November 21, 2007, issue of JAMA, the Journal of the American Medical Association. According to a recent Institute of Medicine report, between 44,000 and 98,000 deaths per year occur in hospitals in the United States as a result of errors. Since the report was published, the Institute of Healthcare Improvement has recommended that RRTs (ICU-trained personnel who are available 24 hours a day, 7 days a week, for evaluation of patients not in the ICU who develop signs or symptoms of clinical deterioration) be implemented nationwide in an effort to decrease inpatient mortality rates. The goal of the study described in this article was to evaluate the effect of RRT implementation on hospital-wide mortality rates and code (respiratory and cardiopulmonary arrests) rates outside the ICU in pediatric inpatients at an academic children's hospital.

The authors conducted a cohort study using historical controls at the main campus of Lucile Packard Children's Hospital (LPCH), a 264-bed quaternary care children's hospital. Participants were included if they were admitted to LPCH between January 1, 2001, and March 31, 2007, and spent at least 1 day on the non-obstetric, non-nursery-based, non-ICU medical or surgical wards. A total of 22,037 patient admissions and 102,537 patient days were evaluated preintervention (before September 1, 2005), and 7,257 patient admissions and 34,420 patient days were evaluated postintervention (on or after September 1, 2005.)

The authors found that:

  • A significant decrease in the hospital-wide mortality rate of 18% occurred after RRT implementation. Mean monthly mortality rates preintervention and postintervention were 1.01 and 0.83 deaths per 100 discharges, respectively.
  • The rate of codes outside the ICU per 1,000 eligible patient-days decreased by 71.2% after RRT implementation, with preintervention and postintervention rates of 0.52 and 0.15, respectively.
  • The rate of codes outside the ICU per 1,000 eligible admissions decreased by 71.7%, with preintervention and postintervention rates of 2.45 and 0.69, respectively.
  • The estimated code rate per 1,000 admissions for the postintervention group was 0.28 times that for the preintervention group.

The authors conclude that "the potential implications of these findings on national mortality rates for children are dramatic."

Citation:
Sharek, P.J., Parast, L.M., Leong, K., Coombs, J., Earnest, K., Sullivan, J. et al. (2007). Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children's hospital. JAMA, the Journal of the American Medical Association 298(19):2267-2274.

Abstract available here.

Source:
MCH Alert
Maternal and Child Health Library
Georgetown University