Rapid response teams (RRTs) were initially designed to identify and treat patients undergoing acute clinical deterioration before the onset of irreversible complications such as cardiac arrest. However, despite their conceptual appeal, evidence supporting their efficacy in reducing hospital mortality has been inconsistent. Moreover, little has been known about the economic implications of such interventions. A recent retrospective cohort study at a Brazilian philanthropic quaternary hospital sought to clarify this by evaluating the impact of transitioning to a dedicated RRT model. Focusing on patients requiring unplanned ICU admission, the study measured changes in clinical outcomes and hospital expenditure over a four-year period.
Structured Intervention and Study Design
The hospital had an established RRT since 2006, composed of various medical professionals drawn ad hoc from emergency or ICU teams. On 1 June 2014, it shifted to a dedicated 24/7 RRT consisting of experienced physicians and trained nursing staff. This new structure aimed to provide faster, more consistent responses to acute deterioration. A retrospective single-centre cohort study was conducted using data from patients requiring unplanned ICU transfers between May 2012 and June 2016, with a 60-day washout period around the transition. The cohort was divided into PRE and POST groups based on the date of ICU admission relative to the RRT implementation.
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Propensity score matching was used to create comparable groups, adjusting for demographic and clinical variables, including age, sex, Charlson Comorbidity Index, SAPS III and SOFA scores. This ensured the differences in outcomes could be more confidently attributed to the intervention rather than underlying patient characteristics. Ultimately, 343 matched patient pairs were analysed across multiple clinical and financial endpoints, including in-hospital mortality, ICU mortality, length of stay, ICU readmissions, use of support interventions and hospital costs.
Improved Clinical Outcomes
The analysis revealed significant improvements in clinical outcomes following the implementation of the dedicated RRT. In-hospital mortality dropped from 34.7% to 22.7% in the POST group, while ICU mortality decreased from 19.5% to 12.8%. These reductions are notable given the similarity in baseline health status between groups, as established by the matching process. Additionally, patients in the POST group experienced shorter hospital and ICU stays, suggesting more efficient clinical management and earlier identification of deterioration.
Support interventions within the ICU, such as the use of vasoactive drugs and non-invasive ventilation, also declined in the POST group, while mechanical ventilation and renal replacement therapy rates remained unchanged. These findings imply that earlier intervention through a dedicated RRT may prevent the escalation of patient conditions that necessitate intensive support. ICU readmission rates within 48 hours showed no significant difference between groups, further supporting the stability of outcomes achieved during initial ICU stays.
Economic Benefits and Limitations
Beyond clinical improvements, the dedicated RRT model was associated with a substantial financial benefit. After adjusting hospital costs for inflation and currency conversion, a 23.2% reduction in median hospital expenditure per patient was observed. This decrease occurred despite the institution operating on a fee-for-service model, where increased interventions typically drive higher charges. The drop in costs is consistent with reduced hospital length of stay and lower use of certain ICU resources.
Nevertheless, the study had limitations. Its retrospective and observational nature introduces potential biases inherent to non-randomised research, although robust data extraction and rigorous propensity score matching mitigate these concerns. Furthermore, only patients who required ICU admission were included, leaving the broader impact of the RRT on other patient populations unexamined. The general improvements in healthcare practices over the four-year period may have influenced outcomes, though the mortality reduction in the matched ICU cohort notably exceeded the institution-wide trend.
The implementation of a dedicated RRT at a Brazilian hospital was linked to meaningful reductions in both in-hospital mortality and overall hospital expenditure for patients requiring unplanned ICU admission. These findings suggest that structuring emergency response around a consistent, highly trained team enables earlier interventions, reducing the severity of deterioration and associated resource use. Given the dual clinical and economic benefits demonstrated, broader adoption of dedicated RRTs should be considered, particularly in institutions managing complex and high-risk patient populations. Future studies in varied healthcare settings and cost-effectiveness evaluations will be crucial to confirming and extending these findings.
Source: International Journal for Quality in Health Care
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