The impact of implementing a rapid response system: A comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia

• Published in: Resuscitation 2014-09, Vol.85 (9), p.1275-1281
• Main Authors: Chen, Jack, Ou, Lixin, Hillman, Ken, Flabouris, Arthas, Bellomo, Rinaldo, Hollis, Stephanie J, Assareh, Hassan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Australia; Cardiac arrests; Emergency; Female; Heart Arrest - mortality; Heart Arrest - therapy; Hospital Mortality; Hospital Rapid Response Team; Hospitals, Teaching; Humans; Male; Medical emergency team; Middle Aged; Rapid response systems; Rapid response team; Unexpected deaths; Young Adult
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2014.06.003

Abstract Aims To compare clinical outcomes between a teaching hospital with a mature rapid response system (RRS), with three similar teaching hospitals without a RRS in Sydney, Australia. Methods For the period 2002–2009, we compared a teaching hospital with a mature RRS, with three similar teaching hospitals without a RRS. Two non-RRS hospitals began implementing the system in 2009 and a third in January 2010. We compared the rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality, overall hospital mortality and 1-year post discharge mortality after IHCA between the RRS hospital and the non-RRS hospitals based on three separate analyses: (1) pooled analysis during 2002–2008; (2) before–after difference between 2008 and 2009; (3) after implementation in 2009. Results During the 2002–2008 period, the mature RRS hospital had a greater than 50% lower IHCA rate, a 40% lower IHCA-related mortality, and 6% lower overall hospital mortality. Compared to 2008, in their first year of RRS (2009) two hospitals achieved a 22% reduction in IHCA rate, a 22% reduction in IHCA-related mortality and an 11% reduction in overall hospital mortality. During the same time, the mature RRS hospital showed no significant change in those outcomes but, in 2009, it still achieved a crude 20% lower IHCA rate, and a 14% lower overall hospital mortality rate. There was no significant difference in 1-year post-discharge mortality for survivors of IHCA over the study period. Conclusions Implementation of a RRS was associated with a significant reduction in IHCA, IHCA-related mortality and overall hospital mortality.