The Extended Rapid Response System: 1-Year Experience in a University Hospital

Abstract

The rapid response system (RRS) is an innovative system designed for in-hospital, at-riskpatients but underutilization of the RRS generally results in unexpected cardiopulmonaryarrests. We implemented an extended RRS (E-RRS) that was triggered by actively screeningat-risk patients prior to calls from primary medical attendants. These patients wereidentified from laboratory data, emergency consults, and step-down units. A fourmemberrapid response team was assembled that included an ICU staff, and the teamvisited the patients more than twice per day for evaluation, triage, and treatment of thepatients with evidence of acute physiological decline. The goal was to provide thistreatment before the team received a call from the patient’s primary physician. We soughtto describe the effectiveness of the E-RRS at preventing sudden and unexpected arrestsand in-hospital mortality. Over the 1-yr intervention period, 2,722 patients were screenedby the E-RRS program from 28,661 admissions. There were a total of 1,996 E-RRSactivations of simple consultations for invasive procedures. After E-RRS implementation,the mean hospital code rate decreased by 31.1% and the mean in-hospital mortality ratewas reduced by 15.3%. In conclusion, the implementation of E-RRS is associated with areduction in the in-hospital code and mortality rates.