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 (RRTs) 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 intensive care unit (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 RRT leadership to a dedicated group on 1 June 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 1 May 2012, and 30 April 2014, and the POST group included those admitted to the ICU between 1 July 2014, and 30 June 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 ICU mortality, hospital and ICU length of stay, ICU readmission rate within 48 h, 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 < .001) and ICU mortality rate (19.5% PRE vs. 12.8% POST; odds ratio 0.501 [95% CI: 0.087-0.915]; P = .022). Decreases in hospital and ICU length of stay and use of ICU support measures were also observed, accompanied by a 23.2% reduction in hospital expenditure (P < .001).

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