Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: A systematic review and meta-analysis

Abstract

Background: In 2004, the Institute for Healthcare Improvement's 100,000 Lives Campaign recommended that hospitals implement rapid response teams (RRTs) charged with identifying non-intensive care unit (ICU) patients at risk for rapid deterioration. Although RRTs are now in widespread use, there have been conflicting results regarding the impact of RRTs on hospital mortality and cardiopulmonary arrest.

Purpose: To assess the effectiveness of RRTs on reducing hospital mortality and non-ICU cardiopulmonary arrest rates.

Data sources: We conducted a systematic review using MEDLINE (1966-2014), Cochrane Central Register of Controlled Trials (1898-2014), Cumulative Index to Nursing and Allied Health Literature (1994-2014), and ClinicalTrials.gov (1997-2014) during October 2014. There were no constraints on language or publication status.

Data extraction: We included before-after studies, cohort studies, and cluster randomized trials that reported hospital mortality and/or non-ICU cardiopulmonary arrest for adults hospitalized in a non-ICU setting after the implementation of RRTs and/or medical emergency teams (METs). Data were extracted by 2 sets of 2 independent reviewers using a standardized data-collection form. Disagreements were resolved by a third reviewer. Authors were contacted to obtain any missing data.

Data synthesis: Our search identified 691 studies, of which 30 met criteria for inclusion in the analysis. Implementation of an RRT/MET was associated with a significant decrease in hospital mortality (relative risk [RR] = 0.88, 95% confidence interval [CI]: 0.83-0.93, I(2) = 86%, 3,478,952 admissions) and a significant decrease in the number of non-ICU cardiac arrests (RR = 0.62, 95% CI: 0.55-0.69, I(2) = 71%, 3,045,273 admissions).

Conclusions: Implementation of an RRT/MET is associated with a reduction in both hospital mortality and non-ICU cardiopulmonary arrests. Journal of Hospital Medicine 2016;11:438-445. © 2016 Society of Hospital Medicine.