Mortality and Length of Stay Trends Following Implementation of a Rapid Response System and Real-Time Automated Clinical Deterioration Alerts.

A study was performed to determine the potential influence of a rapid response system (RRS) employing real-time clinical deterioration alerts (RTCDAs) on patient outcomes involving 8 general medicine units. Introduction of the RRS occurred in 2006 with staged addition of the RTCDAs in 2009. Statistically significant year-to-year decreases in mortality were observed through 2014 ( r = -.794; P = .002). Similarly, year-to-year decreases in the number of cardiopulmonary arrests (CPAs; r = -.792; P = .006) and median lengths of stay ( r = -.841; P = .001) were observed. There was a statistically significant year-to-year increase in the number of RRS activations for these units ( r = .939; P < .001) that was inversely correlated with the occurrence of CPAs ( r = -.784; P = .007). In this single-institution retrospective study, introduction of a RRS employing RTCDAs was associated with lower hospital mortality, CPAs, and hospital length of stay.

A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.

BACKGROUND: Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs. OBJECTIVE: To determine if real-time alerts sent to the rapid response team (RRT) improved patient care. DESIGN: Randomized, controlled trial. SETTING: Eight medicine units (Barnes-Jewish Hospital). PATIENTS: Five hundred seventy-one patients. INTERVENTION: Real-time alerts generated by a validated deterioration algorithm were sent real-time to the RRT (intervention) or hidden (control). MEASUREMENTS: Intensive care unit (ICU) transfer, hospital mortality, hospital duration. RESULTS: ICU transfer (17.8% vs 18.2%; odds ratio: 0.972; 95% confidence interval [CI]: 0.635-1.490) and hospital mortality (7.3% vs 7.7%; odds ratio: 0.947; 95% CI: 0.509-1.764) were similar for the intervention and control groups. The number of patients requiring transfer to a nursing home or long-term acute care hospital was similar for patients in the intervention and control groups (26.9% vs 26.3%; odds ratio: 1.032; 95% CI: 0.712-1.495). Hospital duration (8.4 ± 9.5 days vs 9.4 ± 11.1 days; P = 0.038) was statistically shorter for the intervention group. The number of RRT calls initiated by the primary care team was similar for the intervention and control groups (19.9% vs 16.5%; odds ratio: 1.260; 95% CI: 0.823-1.931). CONCLUSIONS: Real-time alerts sent to the RRT did not reduce ICU transfers, hospital mortality, or the need for subsequent long term care. However, hospital length of stay was modestly reduced.