Critically ill, well assessed Evaluation of the rapid response system in a university medical centre
Friede Simmes
Introduction
Rapid response systems (RRS) are based on the concept that if instable vital functions are timely identified and corrected, serious adverse events (SAEs) may be prevented or patient’s outcome may improve. The afferent limb of the RRS stands for detecting critically ill patients and triggering for adequate help. The efferent limb includes the assessment of the patient by a specialized medical emergency team (MET).
Aim
The aim of this thesis is to gain insight in the effect of the RRS on SAEs in surgery patients and the effect of a multifaceted implementation strategy on adherence of the ward staff to the afferent procedure. Furthermore, we assessed the effects of an RRS on health related quality of life (HRQOL) and on hospital costs.
Methods
A retrospective before-after study of surgical patients in a university hospital. In addition, we performed a scenario analysis to test the hypothesis that admitting patients to the ICU with lower physiological assessment and chronic health evaluation (APACHE II) scores would reduce hospital costs.
Results/conclusion/discussion
Introduction of an RRS showed no significant decrease in cardiac arrest and/or unexpected death. In contrast, the number of unplanned intensive care unit (ICU) admissions increased significantly. MET calls were absent or delayed in over 50% of the SAEs although clear warning criteria were present. From these data we cannot conclude that implementing an RRS is not useful. The study may be underpowered due the low baseline incidence of cardiac arrest and/or unexpected death. Moreover, absent or delayed MET activation may have had a negative impact on the results. We found no effect of RRS implementation on HRQOL 3 and 6 months following surgery. We question whether an RRS influences the quality of life after hospitalization since other factors probably are of far more impact on HRQOL. The total RRS costs were € 27 per patient day. Most of the costs were explained by the increased unplanned ICU days after RRS implementation. Our scenario analysis suggests that the number of ICU days per 1000 patient days can be considerably reduced, resulting in lower costs, when patients are admitted to the ICU while less severely ill, even though considerably more MET consults and unplanned ICU admissions would be expected. Therefore, further implementation strategies should aim at a more intensive use of the MET and a policy to refer less sick patients to the ICU.
Keywords: rapid response system, Medical Emergency Team, patient safety, serious adverse events, health related quality of life, surgical patients, hospital costs
