Bradford D. Winters, MD, PhD; Sallie J. Weaver, PhD; Elizabeth R. Pfoh, MPH; Ting Yang, PhD; Julius Cuong Pham, MD, PhD; Sydney M. Dy, MD, MSc
Note: The Agency for Healthcare Research and Quality reviewed contract deliverables to ensure adherence to contract requirements and quality, and a copyright release was obtained from the Agency for Healthcare Research and Quality before submission of the manuscript.
Disclaimer: All statements expressed in this work are those of the authors and should not in any way be construed as official opinions or positions of the Johns Hopkins University, Agency for Healthcare Research and Quality, or U.S. Department of Health and Human Services.
Financial Support: From the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (contract HHSA-290- 2007-10062I).
Potential Conflicts of Interest: Dr. Winters: Grant (money to institution): Agency for Healthcare Research and Quality; Employment: Johns Hopkins University; Expert testimony: several law firms; Payment for lectures including service on speakers bureaus: 3M; Royalties: Lippincott. Dr. Weaver: Grant (money to institution): Agency for Healthcare Research and Quality; Travel/accommodations/meeting expenses unrelated to activities listed: Improvement Science Research Network. Ms. Pfoh: Grant (money to institution): Agency for Healthcare Research and Quality. Dr. Dy: Grant (money to institution): Agency for Healthcare Research and Quality. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2568.
Requests for Single Reprints: Bradford D. Winters, MD, PhD, Department of Anesthesiology and Critical Care Medicine and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Zayed 9127, 1800 Orleans Street, Baltimore, MD 21287; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Winters, Weaver, Yang, and Pham: Department of Anesthesiology and Critical Care Medicine and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, 750 East Pratt Street, 15th Floor, Baltimore, MD 21231.
Ms. Pfoh and Dr. Dy: Department of Health Policy and Management, Johns Hopkins University, Hampton House, Room 609, 624 North Broadway, Baltimore, MD 21205.
Author Contributions: Conception and design: B.D. Winters, S.J. Weaver, J.C. Pham, S.M. Dy.
Analysis and interpretation of the data: B.D. Winters, T. Yang, J.C. Pham, S.M. Dy.
Drafting of the article: B.D. Winters, S.J. Weaver, E.R. Pfoh, J.C. Pham, S.M. Dy.
Critical revision of the article for important intellectual content: B.D. Winters, J.C. Pham, S.M. Dy.
Final approval of the article: B.D. Winters, S.J. Weaver, E.R. Pfoh, J.C. Pham, S.M. Dy.
Provision of study materials or patients: B.D. Winters.
Statistical expertise: T. Yang, J.C. Pham.
Obtaining of funding: S.M. Dy.
Administrative, technical, or logistic support: E.R. Pfoh.
Collection and assembly of data: B.D. Winters, S.J. Weaver, E.R. Pfoh, S.M. Dy.
Rapid-response systems (RRSs) are a popular intervention in U.S. hospitals and are supported by accreditors and quality improvement organizations. The purpose of this review is to evaluate the effectiveness and implementation of these systems in acute care settings. A literature search was performed between 1 January 2000 through 30 October 2012 using PubMed, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials. Studies published in any language evaluating outcome changes that occurred after implementing an RRS and differences between groups using and not using an RRS (effectiveness) or describing methods used by RRSs (implementation) were reviewed.
A single reviewer (checked by a second reviewer) abstracted data and rated study quality and strength of evidence. Moderate-strength evidence from a high-quality meta-analysis of 18 studies and 26 lower-quality before-and-after studies published after that meta-analysis showed that RRSs are associated with reduced rates of cardiorespiratory arrest outside of the intensive care unit and reduced mortality. Eighteen studies examining facilitators of and barriers to implementation suggested that the rate of use of RRSs could be improved.
Studies that reported the outcome of non–intensive care unit adult cardiorespiratory arrest.
Studies that reported the outcome of total hospital adult mortality.
Studies that reported the outcome of non–intensive care unit pediatric cardiorespiratory arrest.
Studies that reported the outcome of total hospital pediatric mortality.
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Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-Response Systems as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158:417-425. doi: 10.7326/0003-4819-158-5-201303051-00009
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Published: Ann Intern Med. 2013;158(5_Part_2):417-425.
Healthcare Delivery and Policy, Hospital Medicine, Pulmonary/Critical Care.
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