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The effect of a rapid response team implementation in a private hospital

ROSELAINE PINHEIRO DE OLIVEIRA, JUÇARA GASPARETTO MACCARI, TULIO FREDERICO TONIETTO, ANDRE SANTANA MACHADO, CASSIANO TEIXEIRA, PATRICIA DE CAMPOS BALZANO, JOSE HERVE DIEL BARTH, FLAVIO ANDRE CARDONA ALVES, SERGIO FERNANDO MONTEIRO BRODT, EUBRANDO SILVESTRE OLIVEIRA, NILTON BRANDAO DA SILVA

Em: European Society of Intensive Care Medicine. Annual Congress. 22. , 2009, Viena, v. 0, p. 0-0.

Motivo: Produção Corpo Clínico

Setor HMV: Iep Supervisao e Coordenação, CTI Adulto

Área da saúde: Medicina Intensiva

Resumo: INTRODUCTION. Adult patients often exhibit physiological deterioration hours before cardiopulmonary arrest. As a result, the Institute for Healthcare Improvement (IHI) recommended that hospitals implement rapid response teams (RRT) as 1 of 6 strategies to result preventable in-hospital deaths. OBJECTIVE. To determine the effect of a rapid response team on the rate of in-hospital cardiac arrests, total and unplanned intensive care unit admissions, and ICU and hospital mortality before and after implementation of a rapid response team. METHODS. Prospective controlled cohort before RRT (August/2007 - April/2008) and after RRT (May/2008 - February/2009) in a general ICU (31 beds). Standard criteria were used to activate the RRT and included acute changes in the patient´s mental status, respiratory rate, heart rate, oxygenation, or blood pressure and hypoxia, chest pain, or worry from clinical staff. We measured: admitting diagnosis, criteria to activate the RRT and interventions. RESULTS. Before RRT 610 patients were admitted in the ICU and 24% from ward. The most common reasons for admission at ICU were ventilatory dysfunction (36%), shock (19%), cardiac changes (11%) and acute neurological changes (11%). After RRT were a total the 276 activations. The most common reasons for RRT activation were ventilator dysfunction (39%), cardiac changes (22%) and acute neurological changes (16%). 22% were transferred to ICU and the main reasons were cardiac changes (39%), ventilatory dysfunction (36%) and acute neurological changes (16%). In 59% was made a respiratory intervention and in 44% a hemodynamic intervention. The patients admitted before TRR were older (69±15 vs. 75±15, p=0,012). After RRT implementation, mean in-hospital cardiac arrests decrease (14 vs. 8, p=0,048). The ICU mortality (23% vs. 27%, p=0,58) and hospital mortality (62% vs. 61%, p=0.87) did not differ between before and after RRT. CONCLUSIONS. The RRT implementation was associated with decreases in rates of in-hospital cardiac arrest, but was not associated with reductions in hospital or ICU mortality. REFERENCE: 1. Berwick, D.M.; Calkins, D.R.; McCannon, C.J.; Hackbarth, A.D. The 100.000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA, 2006; 295(3):324-327.

Link: http://poster-consultation.esicm.org/ModuleConsultationPoster/consultationPoster.aspx?intIdPoster=330

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