A randomized trial of real‐time automated clinical deterioration alerts sent to a rapid response team. Issue 7 (7th April 2014)

• Record Type: Journal Article
• Authors: Kollef, Marin H.; Chen, Yixin; Heard, Kevin; LaRossa, Gina N.; Lu, Chenyang; Martin, Nathan R.; Martin, Nelda; Micek, Scott T.; Bailey, Thomas
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 7(2014)
• Page Start: 424
• Page End: 429
• Publication Date: 2014-04-07
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2193
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2193-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs.</p> </sec> <sec id="jhm2193-sec-0002" sec-type="section"> <title>OBJECTIVE</title> <p>To determine if real‐time alerts sent to the rapid response team (RRT) improved patient care.</p> </sec> <sec id="jhm2193-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Randomized, controlled trial.</p> </sec> <sec id="jhm2193-sec-0004" sec-type="section"> <title>SETTING</title> <p>Eight medicine units (Barnes‐Jewish Hospital).</p> </sec> <sec id="jhm2193-sec-0005" sec-type="section"> <title>PATIENTS</title> <p>Five hundred seventy‐one patients.</p> </sec> <sec id="jhm2193-sec-0006" sec-type="section"> <title>INTERVENTION</title> <p>Real‐time alerts generated by a validated deterioration algorithm were sent real‐time to the RRT (intervention) or hidden (control).</p> </sec> <sec id="jhm2193-sec-0007" sec-type="section"> <title>MEASUREMENTS</title> <p>Intensive care unit (ICU) transfer, hospital mortality, hospital duration.</p> </sec> <sec id="jhm2193-sec-0008" sec-type="section"> <title>RESULTS</title> <p>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; <italic>P =</italic> 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).</p> </sec> <sec id="jhm2193-sec-0009" sec-type="section"> <title>CONCLUSIONS</title> <p>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. <italic>Journal of Hospital Medicine</italic> 2014;9:424–429. © 2014 Society of Hospital Medicine</p> </sec> </abstract>