The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review

Abstract

Objective: The aim of this systematic review was to synthesize the evidence on the impact of rapid response teams (RRTs) on failure to rescue events.

Methods: Systematic searches were conducted using CINAHL, MEDLINE, PsychINFO, and Cochrane, for articles published from 2008 to 2018. English-language, peer-reviewed articles reporting the impact of RRTs on failure to rescue events, including hospital mortality and in-hospital cardiac arrest events, were included. For selected articles, the authors abstracted information, with the study designed to be compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results: Ten articles were identified for inclusion: 3 meta-analyses, 3 systematic reviews, and 4 single studies. The systematic reviews and meta-analyses were of moderate-to-high quality, limited by the methodological quality of the included individual studies. The single studies were both observational and investigational in design. Patient outcomes included hospital mortality (8 studies), in-hospital cardiac arrests (9 studies), and intensive care unit (ICU) transfer rates (5 studies). There was variation in the composition of RRTs, and 4 studies conducted subanalyses to examine the effect of physician inclusion on patient outcomes.

Conclusions: There is moderate evidence linking the implementation of RRTs with decreased mortality and non-ICU cardiac arrest rates. Results linking RRT to ICU transfer rates are inconclusive and challenging to interpret. There is some evidence to support the use of physician-led teams, although evaluation of team composition was variable. Lastly, the benefits of RRTs may take a significant period after implementation to be realized, owing to the need for change in safety culture.

FIGURE 1

Conceptual model for RRSs. Model depicting the 2 arms of an RRS: the afferent limb, in which the detection of patient deterioration occurs, and the efferent limb, in which the response team is activated. The response teams have the ability to assess, diagnose, and provide treatment, and have the ability to rapidly triage and transfer the patient to an appropriate level of care. Specialized resources may be called in to supplement the response team.