Rapid response system cuts in-hospital cardiac arrests
MedWire News: Implementation of a rapid response system (RRS) significantly reduced cardiac arrests in a Veterans Affairs (VA) hospital over a 2-year period, researchers report.
The medical emergency "eTeam" comprised an intensive care unit (ICU) fellow, attending, and nurse, an anesthesiologist, a respiratory therapist, a pharmacist, and a medicine resident. Other staff in the hospital were given a set of criteria for activating the eTeam, including airway, breathing, circulatory, and neurologic criteria.
During 27 months of operation, the eTeam was called out 378 times. Respiratory insufficiency was the cause of 32% of calls, although other criteria, such as hypotension, were also present in most cases.
The calls lasted about 30 minutes, and 58% resulted in the patient's transfer to a higher level of care, show the findings published in the journal Anesthesia & Analgesia.
The eTeam was called out about twice as often during the day as during the night. The researchers speculate that this is due to increased "subtle" monitoring in the daytime, as staff more frequently enter rooms with meals, to give therapy and education, and to transfer other patients.
There were an average of 10.1 cardiac arrests per 1000 discharges during the 9 months before introduction of the eTeam; this fell to 4.36 per 1000 after its introduction.
"The reduction in arrests was not observed immediately," note Geoffrey Lighthall (VA Medical Center, Palo Alto, California, USA) and colleagues. "Rather, the findings were most prominent in the second year of the eTeam."
This is consistent with some previous studies, they say, and may also explain why other, shorter studies failed to show benefits of a rapid response system.
Respiratory arrests fell from 17 per year to 1-2 per year.
These benefits were evident despite the researchers' belief that the system was underused. They note that the proportion of patients with at least one of the eTeam activation criteria before arrest remained unchanged and that two-thirds of patients required ICU transfer, compared with 20-45% in other studies.
Having periodically reviewed cases, Lighthall et al say the reasons for underuse may include physician reluctance to accept help and too infrequent refresher training of nursing and ancillary staff.
Nevertheless, they conclude: "Our results suggest that further reductions in morbidity can be realized by use of RRSs throughout the VA network."
They add: "Larger cooperative studies within the VA system are needed to more definitively assess impacts on mortality."
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By Eleanor McDermid