Steven M. Belknap, MD
What is the effectiveness of rapid-response teams (RRTs) for reducing mortality and cardiopulmonary arrest in hospital patients?
Included studies compared hospitals using RRTs with control hospitals or periods not using RRTs. RRTs are multidisciplinary teams of hospital staff that evaluate, triage, and treat non–intensive care unit (ICU) patients who are clinically deteriorating. Outcomes were hospital mortality and cardiopulmonary arrest outside of the ICU.
MEDLINE, EMBASE/Excerpta Medica, Web of Knowledge, CINAHL, and Evidence-Based Medicine Reviews (1950 to Nov 2008); reference lists; and meeting abstracts (2006 to 2008) were searched for randomized clinical trials or prospective active intervention studies. 17 articles reporting 18 studies (1 271 864 admissions) met the selection criteria; RRT use ranged from 2.5 to 40.3 per 1000 admissions. 13 studies evaluated adults, and 5 evaluated children. 2 studies were randomized controlled trials (RCTs), 12 were before–after studies, 2 were concurrent controls, and 2 were time series. 6 studies were high-quality, 2 were fair-quality, and 10 were low-quality.
Meta-analysis showed that RRTs did not reduce mortality overall or in adults; however, mortality in children was reduced (Table). RRTs reduced cardiopulmonary arrests outside of ICUs in adults, children, and overall (Table). There was significant statistical heterogeneity (I2 = 74% to 90%; P < 0.001) across study results for both outcomes.
Rapid-response teams reduce cardiopulmonary arrests but do not decrease mortality in hospital patients.
Rapid-response teams (RRTs) vs control in hospital patients*
*ICU = intensive care unit; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article using a random-effects model.
Steven M. Belknap. Review: Rapid-response teams do not reduce mortality in hospital patients. Ann Intern Med. 2010;152:JC6–3. doi: 10.7326/0003-4819-152-12-201006150-02003
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Published: Ann Intern Med. 2010;152(12):JC6-3.
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