Rapid Response Teams Don't Cut Hospital Heart Attacks, Death Rates
TUESDAY Dec. 2, 2008 -- Hospital rapid response teams, created to prevent cardiac arrest and deaths in critically ill patients, do not seem to work, a new study finds.
"Many hospitals have implemented these teams over the past decade," said lead researcher Dr. Paul S. Chan, a cardiologist at the Mid America Heart Institute in Kansas City, Mo. "Earlier studies had shown that rapid response teams may decrease code [cardiac arrest] rates for patients in the hospital."
Rapid response teams are usually made up of doctors, nurses and respiratory therapists, whose primary role is to care for patients in the intensive care unit (ICU). The teams are also called to help evaluate patients who are not in the ICU.
"The goal of these teams was to get called, usually by nurses, to patients who are declining and do a rapid assessment and treatment to try to prevent cardiac arrest and deaths," Chan said.
For the study, Chan's team looked at the association between interventions by rapid response teams and changes in cardiac arrests and deaths in a Kansas City hospital. The researchers compared 24,193 patients hospitalized before the start of team intervention with 24,978 patients hospitalized after a rapid response team was put in place.
Over 20 months later, the team had responded 376 times. The usual reasons the team was called was for changes in a patient's mental state, rapid heartbeat called tachycardia, which can lead to cardiac arrest, rapid breathing or abnormally low blood pressure.
Since many patients evaluated by the rapid response team are transferred to the ICU, Chan's group looked at cardiac arrest and deaths both in and out of the ICU.
Before the rapid response team was in place, there were 11.2 cardiac arrests per 1,000 patients. After the team was started, the cardiac arrest rate was 7.5 per 1,000 patients. While there was a reduction in cardiac arrests after the team was in place, the reduction was not statistically significant, Chan said.
Also, the number of deaths after a cardiac arrest did not change after the rapid response team was in place. Before the team, 77.9 percent of patients who arrested died, compared with 76.1 percent after the team began its work, Chan's group found.
In addition, overall hospital deaths did not change after the team was in place. Before the rapid response team, in-hospital deaths were 3.22 per 100 patients, and after intervention the death rate was 3.09 per 100 patients.
"Our findings raise questions whether or not hospitals should be investing huge financial and personnel resources in these teams without a demonstrable benefit," Chan said.
The report is published in the Dec. 3 issue of the Journal of the American Medical Association.
There may be other programs that might reduce cardiac arrests and death in the hospital, Chan noted. "But it's not clear that we can even move the mortality," he said. "Moving mortality on the hospital level is a monumental task."
One expert thinks hospitals should use their resources in areas of proven value.
"The evidence supporting any benefits of rapid response teams has been tenuous at best," said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles. "Yet, based on recommendations to implement rapid response teams by the Institute for Healthcare Improvement, hospitals across the country have diverted substantial resources and personnel to create and staff such teams."
This latest study failed to show reductions in hospital-wide code rates or mortality with a rapid response team, Fonarow added. "Hospitals should focus on performance improvement and patient safety initiatives, which are evidence-based," he said.
For more information on cardiac arrest, visit the U.S. National Library of Medicine.
Posted: December 2008
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