Rapid response teams sound good in theory – specifically skilled nurses as back-up providers for floor emergencies, intervening and escalating patients in times of unexpected deterioration. However, the largest cluster-randomized trial and multiple meta-analyses have failed to show any benefit to rapid response teams.
The response to this high-quality evidence? Irresponsible conclusions based on low-quality retrospective data.
These authors have so much enthusiasm for their product – a rapid response team that proactively rounds on patients – they’re blind to the most obvious holes in their data. They try to retrospectively compare pre- and post-RRT implementation outcomes, despite having essentially only data on floor codes. And, backing up their main conclusion, floor codes are lower post-RRT proactive rounding – of course, floor codes were already trending downwards at the time of implementation.
What happened when the RRT intervened? The same thing as all other studies show – they moved patients to a higher level of care. How did patients fare in the ICU? A third died or were transferred to hospice. Utterly overlooked in the discussion, in which these authors praise their product and their RRT nurses profusely, is the end result of their RRT product appears to be an unchanged mortality – a simple shuffling around the location of in-hospital deaths. Their title implies a result that is simply demonstrated nowhere in the article, yet they continue to lavish themselves with accolades right up through the final conclusion:
“Our study demonstrates proactivity and innovation as an overall approach to inpatient cardiac arrests …. Innovation stems from a dedicated managerial team who routinely evaluates trends in the code data and creatively seeks ways to prevent cardiac arrest from occurring.”
Managerial buzzword self-aggrandizing nonsense.
“Proactive rounding by the rapid response team reduces inpatient cardiac arrests”
http://www.ncbi.nlm.nih.gov/pubmed/23994805
Jeeze Ryan…. tell us what you really think! 🙂
We have a RRT at my hospital that is used fairly commonly. I agree with your comments above and feel that there is very little good quality evidence that shows real benefit. Our ICU director was one of the original lead authors pushing for RRTs over a decade ago. We had a journal club a couple years ago where we bashed the evidence for them. But there did seem to be some practicality to RRTs that is difficult to quantify in a proper study. The biggest benefit was forcing the inpatient teams to properly address code status. As soon as they had a few activations of the team, they were quite quick to make appropriate patients DNR (or NFR). One could reasonably argue that this should have happened earlier anyway. The other "good" aspect of RRTs was felt to be "empowering" the nursing staff to be able to get a doctor to see a deteriorating patient quickly rather than getting the run around that they were on rounds etc.
Of course one needs to think about the harm of a RRT. If the result is sending patients to a higher level of care where they will die anyway. This will substantially increase cost and tie up resources without benefit.
I love that description: "Managerial buzzword self-aggrandizing nonsense."
I hear it so much now that my mind turns off whenever I hear it. I bought the book, "The Triple Aim." Of course it has its merits, but I couldn't get through it; the pearls were hidden among the morass of managerial buzzwords!