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Rapid Response Team Implementation and Hospital Mortality Rates

John H. Sherner, MD
JAMA. 2009;301(16):1658-1660. doi:10.1001/jama.2009.528
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To the Editor: In their cohort study, Dr Chan and colleagues1 showed that rapid response team implementation did not improve mortality at their institution. It is reasonable to expect that the effect of implementing a rapid response team would vary among hospitals and even within different areas of the same hospital, depending on staff resources and experience levels. It would therefore be useful to know additional characteristics of their hospital.

Additionally, the purpose of a rapid response team is to reduce preventable mortality, which may not translate into a statistically significant reduction in overall mortality. Previous studies suggest that patients in approximately 66% of codes show significant vital sign abnormalities (which are the usual triggers for rapid response team activation) in the hours prior to a code.2 It would be interesting to see data on the number of patients who met rapid response team activation criteria before and after implementation and compare the outcomes in this specific subset of patients.

Future studies of rapid response teams should include detailed data on hospital characteristics to allow determination of which facilities are most likely to benefit. Studies should also focus on potential benefits of rapid response teams other than mortality, such as patient and family satisfaction, nursing satisfaction and retention, improved assessment of end-of-life issues, and physician confidence in ward care. Many medical therapies may not have a demonstrable mortality benefit but are still important and beneficial; this may be the case for rapid response teams.

AUTHOR INFORMATION

Financial Disclosures: None reported.

Disclaimer: The opinions expressed are the private views of the author and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

REFERENCES

Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA. Hospital-wide code rates and mortality before and after implementation of a rapid response team.  JAMA. 2008;300(21):2506-2513
PubMedCrossRef
Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest.  Chest. 1990;98(6):1388-1392
PubMedCrossRef

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Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA. Hospital-wide code rates and mortality before and after implementation of a rapid response team.  JAMA. 2008;300(21):2506-2513
PubMedCrossRef
Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest.  Chest. 1990;98(6):1388-1392
PubMedCrossRef
April 22, 2009
Stuart F. Reynolds, MD; Rinaldo Bellomo, MD; Ken Hillman, MBBS
JAMA. 2009;301(16):1658-1660.
April 22, 2009
Paul S. Chan, MD, MSc; John A. Spertus, MD, MPH
JAMA. 2009;301(16):1658-1660.
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