Effects of rapid response systems on clinical outcomes: systematic review and meta-analysis
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TLDR
A systematic literature review of the effects of rapid response systems (RRSs) on clinical outcomes is presented in this article, showing that the effectiveness of RRSs remains unproven.Abstract:
BACKGROUND
A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial.
PURPOSE
To evaluate the effects of RRSs on clinical outcomes through a systematic literature review.
DATA SOURCES
MEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies.
STUDY SELECTION
Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions.
DATA EXTRACTION
Two authors independently determined study eligibility, abstracted data, and classified study quality.
DATA SYNTHESIS
Thirteen studies met inclusion criteria: 1 cluster-randomized controlled trial (RCT), 1 interrupted time series, and 11 before-after studies. The RCT showed no effects on any clinical outcome. Before-after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74-0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65-0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before-after studies.
CONCLUSIONS
Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422–432. © 2007 Society of Hospital Medicine.read more
Citations
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A Systematic Review and Meta-analysis
TL;DR: A systematic review of studies published from January 1, 1950, through November 31, 2008 using PubMed, EMBASE, Web of Knowledge, CINAHL, and all Evidence-Based Medicine Reviews found that randomized clinical trials and prospective studies of RRTs that reported data on changes in the primary outcome of hospital mortality or the secondary outcome of cardiopulmonary arrest cases were included.
Journal ArticleDOI
Rapid Response Teams: A Systematic Review and Meta-analysis.
TL;DR: Although RRTs have broad appeal, robust evidence to support their effectiveness in reducing hospital mortality is lacking and studies frequently found evidence that deaths were prevented out of proportion to reductions in cases of cardiopulmonary arrest, raising questions about mechanisms of improvement.
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ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research.
Joseph L. Nates,Mark E. Nunnally,Ruth M. Kleinpell,Sandralee Blosser,Jonathan Goldner,Barbara Birriel,Clara S. Fowler,Diane Byrum,William Scherer Miles,Heatherlee Bailey,Charles L. Sprung +10 more
TL;DR: These recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of nonbeneficial treatment and rationing.
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A Review of Current and Emerging Approaches to Address Failure-to-Rescue
TL;DR: A wealth of retrospective data exist to support the observation that adverse events in general ward patients are preceded by a significant period (on the order of hours) of physiologic deterioration, and the lack of early recognition of physiological decline plays a major role in the failure-to-rescue problem.
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Critical care transition programs and the risk of readmission or death after discharge from an ICU: a systematic review and meta-analysis.
TL;DR: Critical care transition programs appear to reduce the risk of ICU readmission in patients discharged from ICU to a general hospital ward, and the ideal model for these programs should be explored before recommending implementation.
References
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Journal ArticleDOI
Measuring inconsistency in meta-analyses
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Book
Experimental and Quasi-Experimental Designs for Generalized Causal Inference
TL;DR: In this article, the authors present experiments and generalized Causal inference methods for single and multiple studies, using both control groups and pretest observations on the outcome of the experiment, and a critical assessment of their assumptions.
Journal ArticleDOI
Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
TL;DR: In hospitals with high patient- to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.
Journal ArticleDOI
Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement
TL;DR: This report hopes this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Journal ArticleDOI
CONSORT statement: extension to cluster randomised trials
TL;DR: This paper provides updated and extended guidance, based on the 2010 version of the CONSORT statement and the 2008consORT statement for the reporting of abstracts, on how to report the results of cluster randomised controlled trials.
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