Rapid response team use questioned

Rapid response teams deployed by hospitals to help prevent deaths in deteriorating patients may not make a difference, a study reports.

The medical emergency teams are intended to reduce the number of patients outside intensive care units who stop breathing or whose hearts stop beating. A crew of ICU staffers -- usually nurses and respiratory therapists and sometimes doctors -- are charged with spotting signs of imminent cardiopulmonary arrest and taking measures to stop it.

The influential Institute for Healthcare Improvement of Cambridge has championed rapid response teams, making their implementation one of six recommendations in its campaigns to reduce preventable in-hospital deaths. More than 2,800 hospitals have signed on to introduce the teams.

IHI is standing by its policy.

In the study published in today's Journal of the American Medical Association, researchers tracked patients admitted to a 404-bed hospital in Kansas City, Mo., for three years, both before and after a rapid response team was established. Neither cardiopulmonary arrests nor deaths went down throughout the hospital in 20 months after the rapid response teams were activated.

"We believe that this study provides important new insights regarding the effectiveness and limitations of rapid response team intervention and raises critical questions about whether recommendations to disseminate rapid response teams nationally are warranted without a demonstrable mortality benefit," the authors write.

The Institute for Healthcare Improvement will look at what the JAMA study found in one hospital, Joe McCannon, IHI vice president and director of the 5 Million Lives Campaign, said in an interview today. But its recommendation remain in place.

"Based on evidence and experience, we still believe the rapid response teams and other early detection strategies are an important approach for getting to patients before they have a catastrophic event," he said. "I don't think there's very much debate about the value of early detection or trying to address a patient's needs before a catastrophic cardiac or respiratory event. ... We feel very confident in that intervention and continue to believe it's an important approach."