oa Rapid response team, is it still helpful?

For the last three decades, efforts at improving the survival rate for patients post-cardiopulmonary arrest has remained unattainable. Confronting such challenge has opened the door to devise new strategies to improve patient outcomes at the onset of subtle deterioration, rather than at the point of cardiac arrest.¹ In 2006, the Institute for Healthcare Improvement (IHI) introduced the Rapid Response Team (RRT) concept, also known as the Medical Emergency Team (MET), as one of the six preventative steps needed to save the lives of patients who might otherwise die unnecessarily.² These six recommended interventions were included in a campaign by the IHI called the 100,000 Lives Campaign. A review of the literature was conducted to assess the certainty of clinical outcomes following the implementation of an RRT service within healthcare facilities. The main clinical outcome measures found included reduction of the:

– Incidence of cardiac arrests that occurred outside the intensive care unit (ICU), – Total ICU admissions, – Unplanned ICU admissions, and – Total hospital mortality rate per 1000 discharge.³

Despite the increasing utilization of RRTs worldwide, their effectiveness in reducing hospital mortality has been debated.⁴ However, the purpose of an RRT service is not to improve cardiac arrest management and outcomes. The primary focus of this concept is to identify patients before they deteriorate through improving patient monitoring on general wards (the afferent component) and improving the reliability of the response to deterioration by a dedicated Critical Care Outreach Team, Rapid Response Team, or Medical Emergency Team (the efferent component).⁴ The reliability of such systems depends on the faultless functioning of a “chain of survival” consisting of:

– Timely recording of vital signs, – Improved education and mindset of staff at the bedside to recognize pathological patterns, – Reporting of abnormalities to the efferent team, – Timely and appropriate response by the latter, – Repeating feedback loops.

Metrics to estimate failure rescue rates have been developed and are widely used as indicators of hospital quality. The Agency for Healthcare Research and Quality has developed a measure of failure to rescue intended to address concerns about variation in documentation among reporting institutions and the fact that other metrics of patient safety, such as mortality and complication rates, may be more a measure of patient-related factors than quality of care. Those metrics are limited to some degree in their usefulness because some patients with advanced illness simply do not want life-prolonging interventions, and some adverse occurrences are not preventable. Nevertheless, recognition of failure to rescue as a significant issue and an important quality indicator has prompted numerous studies of the underlying causes and the development of systematic approaches to address them. It is time to stop asking whether RRT “works.” Overall, the balance of evidence indicates that RRTs are effective at reducing cardiorespiratory arrest and mortality. The focus should now be more on how to improve detection of patient deterioration and promote a culture of safety.⁵