Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards

• Published in: PloS one 2020-12, Vol.15 (12), p.e0241816-e0241816
• Main Authors: Mankidy, Babith, Howard, Christopher, Morgan, Christopher K, Valluri, Kartik A, Giacomino, Bria, Marfil, Eddie, Voore, Prakruthi, Ababio, Yao, Razjouyan, Javad, Naik, Aanand D, Herlihy, James P
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Cardiac arrest; Cohort Studies; Critical care; Critical Care - methods; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - prevention & control; Emergency medical care; Emergency medical services; Emergency nursing; Emergency response; Emergency Service, Hospital; Female; Health services; Heart Arrest - epidemiology; Heart Arrest - pathology; Heart Arrest - therapy; Heart rate; Hospital emergency services; Hospital Mortality; Hospital Rapid Response Team; Hospitals; Howard, Christopher; Humans; Intervention; Male; Medical schools; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Mortality; Nurses; Nursing; Patients; People and Places; Prevention; Quality management; R&D; Research & development; Sepsis; Teams; Veterans
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0241816

This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates. In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team. Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED. Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.