A system of care focused on the detection and systematic assessment of patients with clinical instability can yield similar outcomes as rapid-response teams staffed with trained intensive care specialists, according to a study.
In background information for the study, which was published in June on the website of the journal Critical Care Medicine, researchers noted rapid-response teams have become an important part of hospital care in recent years, sending critical care-trained responders to the bedside of decompensating patients. Most rapid-response teams in the United States send a special ICU-based team of additional providers to the bedside of these patients.
Researchers with Beth Israel Deaconess Medical Center in Boston conducted an analysis of 177,347 patients over a 59-month period. They "found that a rapid-response team that relied on providers already assigned to a patient’s care, rather than a separate ICU-based rapid-response team, was associated with a marked reduction in the rate of unexpected mortality," Michael D. Howell, MD, MPH, a critical care specialist at BIDMC and assistant professor of medicine at Harvard Medical School, said in a news release.
BIDMC in 2005 launched a rapid-response model that does not add additional clinical staff to the patient’s care. Instead, it organizes the response of providers who were already assigned to the patient.
The team includes the patient’s nurse, intern, respiratory therapist and the floor’s senior nurse, all of whom respond to a patient’s bedside when confronted with a number of diagnostic factors, such as heart rate, blood pressure, respiratory rater, oxygen saturation or urine output charge within set parameters.
The team can also respond based on concerns of the nurse caring for the patient or be directly called by worried patients or family members. If an initial evaluation warrants a follow-up, a resident and the senior attending physician must be notified.
In a study of cases from 2004 to 2008, researchers found that the BIDMC program resulted in a 65% reduction in the odds of unexpected mortality among all patients admitted to the hospital. The risk of overall in-hospital mortality was 5% lower, but that difference was not statistically significant.
Those findings are relevant to clinicians and policymakers, the researchers said.
"Our lower-staffing intensity approach produces outcomes comparable with ICU-based approaches," Howell and colleagues wrote. "This approach requires no additional clinical staffing, preserves provider continuity (which may limit adverse events) and respects traditional tenets of medical education."
Given issues stemming from the shortage of intensivists, who are called upon to perform out-of-ICU duties, particularly in smaller hospitals, "it may be that intensivists’ time is better spent with the critically ill in the ICU rather than serving as part of a rapid-response team."
To read the study abstract and access the study via subscription or purchase, visit http://bit.ly/SF2Sxw.
In background information for the study, which was published in June on the website of the journal Critical Care Medicine, researchers noted rapid-response teams have become an important part of hospital care in recent years, sending critical care-trained responders to the bedside of decompensating patients. Most rapid-response teams in the United States send a special ICU-based team of additional providers to the bedside of these patients.
Researchers with Beth Israel Deaconess Medical Center in Boston conducted an analysis of 177,347 patients over a 59-month period. They "found that a rapid-response team that relied on providers already assigned to a patient’s care, rather than a separate ICU-based rapid-response team, was associated with a marked reduction in the rate of unexpected mortality," Michael D. Howell, MD, MPH, a critical care specialist at BIDMC and assistant professor of medicine at Harvard Medical School, said in a news release.
BIDMC in 2005 launched a rapid-response model that does not add additional clinical staff to the patient’s care. Instead, it organizes the response of providers who were already assigned to the patient.
The team includes the patient’s nurse, intern, respiratory therapist and the floor’s senior nurse, all of whom respond to a patient’s bedside when confronted with a number of diagnostic factors, such as heart rate, blood pressure, respiratory rater, oxygen saturation or urine output charge within set parameters.
The team can also respond based on concerns of the nurse caring for the patient or be directly called by worried patients or family members. If an initial evaluation warrants a follow-up, a resident and the senior attending physician must be notified.
In a study of cases from 2004 to 2008, researchers found that the BIDMC program resulted in a 65% reduction in the odds of unexpected mortality among all patients admitted to the hospital. The risk of overall in-hospital mortality was 5% lower, but that difference was not statistically significant.
Those findings are relevant to clinicians and policymakers, the researchers said.
"Our lower-staffing intensity approach produces outcomes comparable with ICU-based approaches," Howell and colleagues wrote. "This approach requires no additional clinical staffing, preserves provider continuity (which may limit adverse events) and respects traditional tenets of medical education."
Given issues stemming from the shortage of intensivists, who are called upon to perform out-of-ICU duties, particularly in smaller hospitals, "it may be that intensivists’ time is better spent with the critically ill in the ICU rather than serving as part of a rapid-response team."
To read the study abstract and access the study via subscription or purchase, visit http://bit.ly/SF2Sxw.
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