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Rapid Response TeamsA Systematic Review and Meta-analysis
Paul S. Chan, MD, MSc;
Renuka Jain, MD;
Brahmajee K. Nallmothu, MD, MPH;
Robert A. Berg, MD;
Comilla Sasson, MD, MS
Arch Intern Med. 2010;170(1):18-26.
Background Although rapid response teams (RRTs) increasingly have been adopted by hospitals, their effectiveness in reducing hospital mortality remains uncertain. We conducted a meta-analysis to assess the effect of RRTs on reducing cardiopulmonary arrest and hospital mortality rates.
Methods We conducted a systematic review of studies published from January 1, 1950, through November 31, 2008, using PubMed, EMBASE, Web of Knowledge, CINAHL, and all Evidence-Based Medicine Reviews. Randomized clinical trials and prospective studies of RRTs that reported data on changes in the primary outcome of hospital mortality or the secondary outcome of cardiopulmonary arrest cases were included.
Results Eighteen studies from 17 publications (with 1 treated as 2 separate studies) were identified, involving nearly 1.3 million hospital admissions. Implementation of an RRT in adults was associated with a 33.8% reduction in rates of cardiopulmonary arrest outside the intensive care unit (ICU) (relative risk [RR], 0.66; 95% confidence interval [CI], 0.54-0.80) but was not associated with lower hospital mortality rates (RR, 0.96; 95% CI, 0.84-1.09). In children, implementation of an RRT was associated with a 37.7% reduction in rates of cardiopulmonary arrest outside the ICU (RR, 0.62; 95% CI, 0.46-0.84) and a 21.4% reduction in hospital mortality rates (RR, 0.79; 95% CI, 0.63-0.98). The pooled mortality estimate in children, however, was not robust to sensitivity analyses. Moreover, studies frequently found evidence that deaths were prevented out of proportion to reductions in cases of cardiopulmonary arrest, raising questions about mechanisms of improvement.
Conclusion Although RRTs have broad appeal, robust evidence to support their effectiveness in reducing hospital mortality is lacking.
Author Affiliations: Department of Internal Medicine, Mid America Heart Institute at St Luke's Hospital, University of Missouri–Kansas City (Dr Chan); Departments of Internal Medicine (Drs Jain and Nallmothu) and Emergency Medicine (Dr Sasson), University of Michigan Medical School, and Veterans Administration Ann Arbor Health Services Research & Development Center of Excellence (Dr Nallmothu), Ann Arbor, Michigan; and Department of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Berg).
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