Dedicated Rapid Response Team Implementation Associated with Reductions in Hospital Mortality and Hospital Expenses: A Retrospective Cohort Analysis.

Abstract

Introduction: The clinical impact of the implementation of rapid response teams remains controversial in the literature. Furthermore, data on the financial impact of this intervention remain scarce. Therefore, we aim to assess the impact of the implementation of a dedicated RRT on hospital mortality and hospital expenses of patients experiencing acute clinical deterioration requiring an unplanned ICU admission.

Methods: We conducted a retrospective single-centre cohort study of adult patients experiencing acute clinical deterioration requiring an unplanned ICU admission before and after the transition of the rapid response team leadership to a dedicated group on June 1, 2014. Admissions that occurred 30 days before and 30 days after were excluded because they included the training period of the team members. Therefore, the PRE group encompassed patients who required an unplanned ICU admission between May 1, 2012, and April 30, 2014, and the POST group included those admitted to the ICU between July 1, 2014, and June 30, 2016. Patients were matched by propensity score according to a calibration of 0.2 and at a 1:1 ratio using the nearest neighbour matching method. The primary outcome was in-hospital mortality, with secondary outcomes including intensive care unit mortality, hospital and intensive care unit length of stay, intensive care unit readmission rate within 48 hours, and hospital expenses.

Results: The study included 977 consecutive patients: 470 in the PRE group and 507 in the POST group. Following propensity score matching, 343 pairs (totalling 686 patients) were identified. Analyses revealed reductions in in-hospital mortality rate (34.7% PRE vs. 22.7% POST; odds ratio 0.590 [95% CI: 0.254-0.927], P < 0.001) and intensive care unit mortality rate (19.5% PRE vs. 12.8% POST; odds ratio 0.501 [95% CI: 0.087-0.915]; P = 0.022). Decreases in hospital and intensive care unit length of stay and use of intensive care unit support measures were also observed, accompanied by a 23.2% reduction in hospital expenditure (P < 0.001).

Conclusion: Transitioning to a dedicated rapid response team was associated with reduced in-hospital mortality and hospital resource utilisation. Future research in diverse settings and cost-effectiveness analyses are warranted to confirm these findings and explore the economic impacts of rapid response teams.