The impact of rapid response team on outcome of patients transferred from the ward to the ICU: a single-center study

Craig Karpman, Mark T Keegan, Jeffrey B Jensen, Philippe R Bauer, Daniel R Brown, Bekele Afessa
Critical Care Medicine 2013, 41 (10): 2284-91

OBJECTIVES: To determine the impact of rapid response team implementation on the outcome of patients transferred from the regular hospital ward and nonward locations to the ICU.

DESIGN: Retrospective before-after cohort study.

SETTING: The study was performed in two ICUs, one surgical and one medical, of a tertiary medical center.

PATIENTS: We included 4,890 patients transferred from the hospital ward to two ICUs and 15,855 patients admitted from nonward locations.


MEASUREMENTS AND MAIN RESULTS: Data on each patient were abstracted from the Acute Physiology and Chronic Health Evaluation III and the administrative hospital and rapid response team databases. The study period was divided into pre-rapid response team and rapid response team. A 24/7 critical care consult service and cardiac arrest teams were available for ward patient care during both periods. A total of 20,745 patients were admitted to the two study ICUs, of whom 4,890 were from the ward (2,466 and 2,424 during the pre-rapid response team and rapid response team periods, respectively). The first ICU day severity of illness was higher for the pre-rapid response team period. A multiple logistic regression model that included predicted mortality as a covariate suggested that availability of rapid response team was associated with an increased risk of hospital death in patients transferred to the ICU from the regular ward, odds ratio (95% CI) of 1.273 (1.089-1.490). For the nonward patients, the availability of rapid response team was similarly associated with increased risk of death. The ICU length of stay was shorter during the rapid response team period both in ward transfer and in nonward transfer patients.

CONCLUSIONS: Rapid response team implementation is associated with increased numbers of ICU admissions and rates, and transfer from the ward of less severely ill patients. However, rapid response team implementation did not improve the severity-of-illness-adjusted outcome of patients transferred from the ward. Implementation of rapid response team in an institution with a 24/7 ICU consult service may have unforeseen costs without obvious benefit. Our findings highlight that institutions should evaluate the impact of rapid response team on patient outcome and make modifications specific to their practices.

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