Patient outcomes improved with rapid response system

Critical deterioration may be reversed by implementation of a rapid response system, according to study findings published in JAMA Pediatrics.

Christopher P. Bonafide, MD, MSCE, of the division of general pediatrics, The Children’s Hospital of Philadelphia, and colleagues conducted a study to determine the effect of a rapid response system (RRS) on the rate of critical deterioration events – transfers that required ventilation or vasopressors during the first 12 ICU hours.

Christopher P. Bonafide

The investigators evaluated 1,810 unplanned transfers from the general medical and surgical wards to pediatric and neonatal ICUs between July 2007 and May 2012. They discovered that RRS implementation was associated with a 62% net decrease of critical deterioration (adjusted incidence rate ratio=0.38; 95% CI, 0.2-0.75). There also were reductions in ward cardiac arrests (P=.21) and deaths during ward emergencies (P=.99); however they were not significant reductions. Overall, having a critical deterioration event was associated with a 4.97-fold increased risk of death compared with other unplanned transfers who did not experience critical deterioration (95% CI, 3.33-7.4), according to the study findings.

“This study confirms that RRSs can improve patient outcomes,” Bonafide told Infectious Diseases in Children. “Measuring that improvement can be difficult because the outcomes we typically measure, like cardiac arrests, are very rare. Critical deterioration events are a more common surrogate outcome that clinicians can use to gauge the effectiveness of their hospital’s RRS over time.”

In an accompanying editorial, Rashid Alobaidi, MD, FRCPC, and Ari R. Joffe, MD, FRCPC,of the University of Alberta note that, while a large cluster-randomized trial would be the ideal method to definitively determine whether RRSs are effective, such an approach would be difficult to pursue since the systems are nearly universally implemented.

“Perhaps we need to settle for accepting that current data, including those of Bonafide and colleagues, at least suggest a lack of harm from RRS implementation,” they wrote. “Nevertheless, we need to continue to look for other (and potentially more effective) ways to impact ‘links in the chain of patient rescue.’”

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Disclosure: The study was funded in part by the Health Research Formula Award from the Pennsylvania Department of Health. The researchers report no relevant financial disclosures.