Outcomes associated with the nationwide introduction of Rapid Response Systems in the Netherlands

Ludikhuize, J.; Brunsveld-Reinders, A.H.; Dijkgraaf, M.G.W.; Smorenburg, S.M.; Rooij, S.E.J.A. de; Adams, R.; ... ; Cost Outcomes Med Emergency Teams (2015)

Article / Letter to editor

Objective: To describe the effect of implementation of a Rapid Response System (RRS) on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death.

Design: Pragmatic prospective Dutch multi-center before-after trial, Cost and Outcomes analysis of Medical Emergency Teams (COMET) trial.

Setting: Twelve hospitals participated, each including two surgical and two non-surgical wards between April 2009 and November 2011. The Modified Early Warning Score (MEWS) and Situation-Background-Assessment-Recommendation (SBAR) instruments were implemented over seven months. The Rapid Response Team (RRT) was then implemented during the following 17 months. The effects of implementing the RRT were measured in the last 5 months of this period.

Patients: All patients 18 years and older admitted to the study wards were included.

Measurements and main results: In total 166,569 patients were included in the study representing 1,031,172 hospital admission days. No differences were observed in patient demographics between periods. The composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death per 1000 admissions was significantly reduced in the RRT versus the before phase, adjusted odds ratio (OR) 0.847 (95% CI 0.725-0.989, p=0.036). Cardiopulmonary arrests and in hospital mortality were also significantly reduced, OR 0.607 (95 CI 0.393-0.937, p=0.018) and OR 0.802 (95% CI 0.644-1.0, p=0.05) respectively. Unplanned ICU admissions showed a declining trend, OR 0.878 (95% CI 0.755-1.021, p=0.092) whereas severity of illness at the moment of ICU admission was not different between periods.

Conclusions: In this study, introduction of nationwide implementation of RRSs was associated with a decrease in the composite endpoint of cardiopulmonary arrests, unplanned ICU admissions and mortality in patients on general hospital wards. These findings support the implementation of RRSs in hospitals to reduce severe adverse events.

• All authors: Ludikhuize, J.; Brunsveld-Reinders, A.H.; Dijkgraaf, M.G.W.; Smorenburg, S.M.; Rooij, S.E.J.A. de; Adams, R.; Maaijer, P.F. de; Fikkers, B.G.; Tangkau, P.; Jonge, E. de; Cost Outcomes Med Emergency Teams
• Date: 2015
• DOI: doi:10.1097/CCM.0000000000001272