January 19th, 2010
Do Rapid Response Teams and Remote ICU Monitoring Actually Prevent Deaths?
Hospitals devote a lot of resources to preventing in-hospital cardiac arrests. That makes sense because when one actually occurs, the patient has only a 1 in 6 chance of surviving to discharge. Two popular strategies for helping clinicians recognize and treat clinical deterioration before an in-hospital cardiac arrest are remote ICU monitoring and rapid response teams. After all, it’s intuitively appealing to pay close attention to patients who are doing poorly and, when they deteriorate, to intervene quickly and change their course. Yet, evidence regarding the effectiveness of these two strategies has been mixed.
Recently, my colleagues and I did a meta-analysis of studies about rapid response teams. After analyzing data from 1.3 million admissions, we found that the use of such teams was not associated with lower in-hospital mortality in adults. Similarly, two recent multicenter studies, one published in JAMA and the other in Critical Care Medicine, showed that remote ICU monitoring did not reduce ICU or in-hospital mortality rates, or length of stay.
These findings are especially disappointing because of the vast financial and human resources required to develop and maintain rapid-response-team and remote-ICU-monitoring programs. But I wonder, given the evidence, how much hospitals are accomplishing with these strategies. More important, what if institutions get complacent after they’ve implemented them?
I think we need more data to resolve such questions. But I’d like to ask you: What’s your hospital’s experience with rapid response teams and remote ICU monitoring? Do you think hospitals should continue them in the face of disappointing survival data? Can other “outcomes” touted by these programs, such as nursing satisfaction, be achieved at lower costs? And if your hospital has managed to reduce cardiac arrest rates or improve survival after cardiac arrest using other types of quality-improvement initiatives, please share them with us here on CardioExchange.