Evaluating implementation of a rapid response team: considering alternative outcome measures

Objective. Determine the prolonged effect of rapid response team (RRT) implementation on failure to rescue (FTR). Design. Longitudinal study of institutional performance with control charts and Bayesian change point (BCP) analysis. Setting. Two academic hospitals in Midwest, USA. Participants. All inpatients discharged between 1 September 2005 and 31 December 2010. Intervention. Implementation of an RRT serving the Mayo Clinic Rochester system was phased in for all inpatient services beginning in September 2006 and was completed in February 2008. Main Outcome Measure. Modified version of the AHRQ FTR measure, which identifies hospital mortalities among medical and surgical patients with specified in-hospital complications. Results. A decrease in FTR, as well as an increase in the unplanned ICU transfer rate, occurred in the second-year post-RRT implementation coinciding with an increase in RRT calls per month. No significant decreases were observed pre- and post-implementation for cardiopulmonary resuscitation events or overall mortality. A significant decrease in mortality among non-ICU discharges was identified by control charts, although this finding was not detected by BCP or pre- vs. post-analyses. Conclusions. Reduction in the FTR rate was associated with a substantial increase in the number of RRT calls. Effects of RRT may not be seen until RRT calls reach a sufficient threshold. FTR rate may be better at capturing the effect of RRT implementation than the rate of cardiac arrests. These results support prior reports that short-term studies may underestimate the impact of RRT systems, and support the need for ongoing monitoring and assessment of outcomes to facilitate best resource utilization.