Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states

• Published in: BMJ open 2019-03, Vol.9 (3), p.e024548-e024548
• Main Authors: Mitchell, Oscar J L, Motschwiller, Caroline W, Horowitz, James M, Evans, Laura E, Mukherjee, Vikramjit
• Format: Article
• Language: English
• Subjects: Cardiac arrest; Cardiopulmonary resuscitation; CPR; Critical care; Cross-Sectional Studies; Emergency medical care; Epidemiology; Health care delivery; Heart Arrest - therapy; Heart attacks; Hospital Rapid Response Team - organization & administration; Hospitals; Hospitals - statistics & numerical data; Humans; Intensive Care; Leadership; Medicare; Mid-Atlantic Region; New England; Nursing administration; Outcome Assessment, Health Care; Patients; Personnel, Hospital - statistics & numerical data; Surveys and Questionnaires; Teams; Teamwork
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-024548

ObjectivesTo characterise the variation in composition, leadership, and activation criteria of rapid response and cardiac arrest teams in five north-eastern states of the USA.DesignCross-sectional study consisting of a voluntary 46-question survey of acute care hospitals in north-eastern USA.SettingAcute care hospitals in New York, New Jersey, Rhode Island, Vermont, and Pennsylvania.ParticipantsSurveys were completed by any member of the rapid response team (RRT) with a working knowledge of team composition and function. Participants were all Medicare-participating acute care hospitals, including teaching and community hospitals as well as hospitals from rural, urban and suburban areas.ResultsOut of 378 hospitals, contacts were identified for 303, and 107 surveys were completed. All but two hospitals had an RRT, 70% of which changed members daily. The most common activation criteria were clinical concern (95%), single vital sign abnormalities (77%) and early warning score (59%). Eighty one per cent of hospitals had a dedicated cardiac arrest team.RRT composition varied widely, with respiratory therapists, critical care nurses, physicians and nurse managers being the most likely to attend (89%, 78%, 64% and 51%, respectively). Consistent presence of critical care physicians was uncommon and both cardiac arrest teams and teams were frequently led by trainee physicians, often without senior supervision.ConclusionsAs the largest study to date in the USA, we have demonstrated wide heterogeneity, rapid team turnover and a lack of senior supervision of RRT and cardiac arrest teams. These factors likely contribute to the mixed results seen in studies of RRTs.