reduction in hospital-wide mortality after implementation of a rapid response team a long-term cohort study减少程序后死亡率实现快速反应小组提供一个长期的队列研究.pdfVIP

Beitler et al. Critical Care 2011, 15:R269 /content/15/6/R269 RESEARCH Open Access Reduction in hospital-wide mortality after implementation of a rapid response team: a long- term cohort study 1* 2 2 3 4 Jeremy R Beitler , Nate Link , Douglas B Bails , Kelli Hurdle and David H Chong Abstract Introduction: Rapid response teams (RRTs) have been shown to reduce cardiopulmonary arrests outside the intensive care unit (ICU). Yet the utility of RRTs remains in question, as most large studies have failed to demonstrate a significant reduction in hospital-wide mortality after RRT implementation. Methods: A cohort design with historical controls was used to determine the effect on hospital-wide mortality of an RRT in which clinical judgment, in addition to vital-signs criteria, was widely promoted as a key trigger for activation. All nonprisoner patients admitted to a tertiary referral public teaching hospital from 2003 through 2008 were included. In total, 77, 021 admissions before RRT implementation (2003 through 2005) and 79, 013 admissions after RRT implementation (2006 through 2008) were evaluated. The a priori primary outcome was unadjusted hospital-wide mortality. A Poisson regression model was then used to adjust for hospital-wide mortality trends over time. Secondary outcomes defined a priori were unadjusted out-of-ICU mortality and out-of-ICU cardiopulmonary- arrest codes. Results: In total, 855 inpatient RRTs (10.8 per 1, 000 hospital-wide discharges) were activated during the 3-year postintervention period. Forty-seven percent of RRTs were activated for reasons of clinical judgment. Hospital-wide mortality decreased from 15.50 to 13.74 deaths per 1, 000 discharges after RRT impl