Impact of a standardized rapid response system on outcomes in a large healthcare jurisdiction

Jack Chen; Lixin Ou; Arthas Flabouris; Ken Hillman; Rinaldo Bellomo; Michael Parr

doi:10.1016/j.resuscitation.2016.07.240

Impact of a standardized rapid response system on outcomes in a large healthcare jurisdiction

Resuscitation. 2016 Oct:107:47-56. doi: 10.1016/j.resuscitation.2016.07.240. Epub 2016 Aug 6.

Authors

Jack Chen¹, Lixin Ou², Arthas Flabouris³, Ken Hillman², Rinaldo Bellomo⁴, Michael Parr⁵

Affiliations

¹ Simpson Centre for Health Services Research & Ingham Institute of Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: [email protected].
² Simpson Centre for Health Services Research & Ingham Institute of Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
³ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
⁴ Intensive Care Unit, Austin Medical Centre, Melbourne, Victoria, Australia.
⁵ Intensive Care Unit, Liverpool Hospital, Sydney, Australia.

PMID: 27507434
DOI: 10.1016/j.resuscitation.2016.07.240

Abstract

Aim: To assess the impact of a standardized rapid response system (RRS) implemented across a large health care jurisdiction on reducing serious adverse events, hospital mortality and unexpected deaths.

Method: We conducted an interrupted time series (2007-2013) population-based study in the state of New South Wales (NSW), Australia to evaluate the impact of introducing a statewide standardized RRS (the between-the-flags [BTF] system) which employed a five-component intervention strategy. We studied 9,799,081 admissions in all 232 public hospitals in NSW. We studied changes in trends for annual rates of multiple key patient-centered outcomes before and after its introduction.

Results: Before the BTF system (2007-2009), there was a progressive decrease in mortality, cardiac arrest rates, cardiac arrests related mortality, and failure to rescue rates, but no changes in mortality rate among low mortality diagnostic related group (LMDRGs) patients. After the BTF program (2010-2013), the same trends continued for all outcomes with an overall (2013 vs 2007) 46% reduction in cardiac arrest rates; a 54% reduction in cardiac arrest related mortality rates; a 19% reduction in hospital mortality; a 35% decrease in failure to rescue rates (all Ps<0.001) over seven-years. In addition, there was a new 20% (p<0.001) mortality reduction among LMDRG patients (2013 vs 2007).

Conclusions: The BTF program was associated with continued decrease in the overall cardiac arrests rates, deaths after cardiac arrest, hospital mortality and failure to rescue. In addition, among patients in the LMDRC group, it induced a new and significant post-intervention reduction in mortality which was never reported before.

Keywords: Cardiopulmonary arrests; Medical emergency team; Rapid response system; Rapid response team.

MeSH terms

Adult
Aged
Benchmarking
Critical Care / methods
Critical Care / standards
Female
Heart Arrest* / mortality
Heart Arrest* / therapy
Hospital Mortality / trends
Hospital Rapid Response Team* / organization & administration
Hospital Rapid Response Team* / standards
Hospitalization / statistics & numerical data
Hospitals, Public* / organization & administration
Hospitals, Public* / standards
Hospitals, Public* / statistics & numerical data
Humans
Interrupted Time Series Analysis
Male
Middle Aged
New South Wales / epidemiology
Outcome and Process Assessment, Health Care
Program Evaluation
Survival Analysis