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Rapid response systems: a systematic review and meta-analysis.

Maharaj R, Raffaele I, Wendon J - Crit Care (2015)

Bottom Line: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain.The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population.Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

View Article: PubMed Central - PubMed

Affiliation: Kings College London, Denmark Hill, London, SE5 9RW, UK. ritesh.maharaj@kcl.ac.uk.

ABSTRACT

Introduction: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.

Method: We conducted a systematic review of studies published from January 1, 1990, through 31 December 2013, using PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests.

Results: Twenty-nine eligible studies were identified. The studies were analysed in groups based on adult and paediatric trials that were further sub-grouped on methodological design. There were 5 studies that were considered either cluster randomized control trial, controlled before after or interrupted time series. The remaining studies were before and after studies without a contemporaneous control. The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population. There was substantial heterogeneity in both populations. The rapid response system team was also associated with a reduction in cardiopulmonary arrests in adults (RR 0.65, 95 % CI 0.61-0.70, p<0.001) and paediatric (RR=0.64 95 % CI 0.55-0.74) patients.

Conclusion: Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest. Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

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Related in: MedlinePlus

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Fig1: Literature search flow diagram

Mentions: A systematic review of studies published between 1 January 1990 and 31 December 2013 was conducted in accordance with published guidelines [19, 20]. We used the PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Cochrane Register of Controlled trials databases. Additionally, a hand search of bibliographies of key publications was performed. Search terms included ‘rapid response team’, medical emergency team’ and ‘critical care outreach’. Details of the electronic search are described in Fig. 1 with additional information provided in the supplementary appendix.


Rapid response systems: a systematic review and meta-analysis.

Maharaj R, Raffaele I, Wendon J - Crit Care (2015)

Literature search flow diagram
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489005&req=5

Fig1: Literature search flow diagram
Mentions: A systematic review of studies published between 1 January 1990 and 31 December 2013 was conducted in accordance with published guidelines [19, 20]. We used the PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Cochrane Register of Controlled trials databases. Additionally, a hand search of bibliographies of key publications was performed. Search terms included ‘rapid response team’, medical emergency team’ and ‘critical care outreach’. Details of the electronic search are described in Fig. 1 with additional information provided in the supplementary appendix.

Bottom Line: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain.The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population.Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

View Article: PubMed Central - PubMed

Affiliation: Kings College London, Denmark Hill, London, SE5 9RW, UK. ritesh.maharaj@kcl.ac.uk.

ABSTRACT

Introduction: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.

Method: We conducted a systematic review of studies published from January 1, 1990, through 31 December 2013, using PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests.

Results: Twenty-nine eligible studies were identified. The studies were analysed in groups based on adult and paediatric trials that were further sub-grouped on methodological design. There were 5 studies that were considered either cluster randomized control trial, controlled before after or interrupted time series. The remaining studies were before and after studies without a contemporaneous control. The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population. There was substantial heterogeneity in both populations. The rapid response system team was also associated with a reduction in cardiopulmonary arrests in adults (RR 0.65, 95 % CI 0.61-0.70, p<0.001) and paediatric (RR=0.64 95 % CI 0.55-0.74) patients.

Conclusion: Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest. Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

Show MeSH
Related in: MedlinePlus