Reducing mortality and avoiding preventable ICU utilization: analysis of a successful rapid response program using APR DRGs

Abstract

Even though rapid response teams (RRTs) have been widely adopted, reports about their efficacy in reducing mortality have been conflicting, both in terms of outcomes, and standardization of measures. Our data demonstrate that it is possible to detect significant changes within the patient population while overall mortality rates appear not to change. Our focus will be on three indicators: unplanned transfers to the ICU as an RRT outcomes measure, changes in ICU patient utilization, and mortality. Between 2005 and 2008, RRT intervention had an impact on patient outcomes by reducing the rate of unplanned transfers to our ICU following an RRT event by 35.9%. With less severe patients able to remain on the medical wards, 12.5% of ICU beds were able to be utilized by more severe patients, and the Hospital-Standardized Mortality Ratio decreased 31.2%. The All Patient Refined Diagnostic-Related Groups (APR DRGs) risk of mortality (ROM) was used to stratify and group patients by severity, and revealed reductions in mortality among specific risk groups as well as shifts in the proportion of patient risk groups within the ICU population which were not readily apparent.

Keywords: APR DRG; ICU utilization; RRT; mortality; rapid response team.