Friday, October 19, 2007

Rapid response teams: promoted but not evidence based

Rapid response teams, though promoted by Joint Commission and IHI have not been supported by high level evidence. The latest analysis, a systematic review recently published in Critical Care Medicine, offers little more in the way of evidentiary support for RRTs.

RRTs were marginally effective in preventing cardiac arrest in the pooled analysis of observational studies but not in the only randomized controlled trial (RCT). RRTs had no impact on mortality in any level of study (neither in observational studies nor in the two RCTs). This is consistent with what was known before. Despite these negative findings Joint Commission urges hospitals to use “Rapid Response Systems to Save Lives” and the IHI declares that the use of RRTs is “perhaps the most dramatic of the six strategies at the heart of IHI’s 100,000 Lives Campaign”.

The authors of the systematic review conclude that “Large randomized controlled trials are needed to clarify the efficacy of rapid response systems before they should become standard of care.”

1 comment:

JMAIL said...

How do you propose conducting controlled randomized studies with the heterogeneous nature of deteriorating patients? What kind of controls would be used? Do you take RRT programs off-line to conduct PDCA cycles on specified patient care areas? The utility of of conducting large randomized trials is obtuse and could give opportunity for more patient's to fail. The process of conducting these randomized trials should be ironed out prior to conducting this type of research. The 2008 National Patient Safety Goals mandate that hospitals improve recognition and response to changes in a patient's condition. The science of Rapid response systems is still in it's infancy stages but research and position papers are being published at exponential rates. My institutions RRT has consulted on over 240 patients a month for over three years and we have experienced reductions in Hospital standardized mortality rate as well as reduced number of cardiac arrests outside of the ICU setting. We have also seen positive increases in physician and nurse satisfaction and retention as a result of expert clinical support provided by the RRT.These results are published in an abstract which was presented at the Academy for Healthcare Improvement's scientific symposium in 2006. Much rhetoric is being disseminated about the efficacy of RRS for lack of evidence (Winters/Provenost, Teplick, Iqbal to name a few)but where are the solutions?
John Mailey, RN, BSN, CCRN