Dataset Information

Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states.

ABSTRACT:

Objectives

To characterise the variation in composition, leadership, and activation criteria of rapid response and cardiac arrest teams in five north-eastern states of the USA.

Design

Cross-sectional study consisting of a voluntary 46-question survey of acute care hospitals in north-eastern USA.

Setting

Acute care hospitals in New York, New Jersey, Rhode Island, Vermont, and Pennsylvania.

Participants

Surveys were completed by any member of the rapid response team (RRT) with a working knowledge of team composition and function. Participants were all Medicare-participating acute care hospitals, including teaching and community hospitals as well as hospitals from rural, urban and suburban areas.

Results

Out of 378 hospitals, contacts were identified for 303, and 107 surveys were completed. All but two hospitals had an RRT, 70% of which changed members daily. The most common activation criteria were clinical concern (95%), single vital sign abnormalities (77%) and early warning score (59%). Eighty one per cent of hospitals had a dedicated cardiac arrest team.RRT composition varied widely, with respiratory therapists, critical care nurses, physicians and nurse managers being the most likely to attend (89%, 78%, 64% and 51%, respectively). Consistent presence of critical care physicians was uncommon and both cardiac arrest teams and teams were frequently led by trainee physicians, often without senior supervision.

Conclusions

As the largest study to date in the USA, we have demonstrated wide heterogeneity, rapid team turnover and a lack of senior supervision of RRT and cardiac arrest teams. These factors likely contribute to the mixed results seen in studies of RRTs.

SUBMITTER: Mitchell OJL

PROVIDER: S-EPMC6429839 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states.

Mitchell Oscar J L OJL Motschwiller Caroline W CW Horowitz James M JM Evans Laura E LE Mukherjee Vikramjit V

BMJ open 20190308 3

<h4>Objectives</h4>To characterise the variation in composition, leadership, and activation criteria of rapid response and cardiac arrest teams in five north-eastern states of the USA.<h4>Design</h4>Cross-sectional study consisting of a voluntary 46-question survey of acute care hospitals in north-eastern USA.<h4>Setting</h4>Acute care hospitals in New York, New Jersey, Rhode Island, Vermont, and Pennsylvania.<h4>Participants</h4>Surveys were completed by any member of the rapid response team (R ...[more]

PMID: 30852537

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Project description:Despite improvements in the management of in-hospital cardiac arrest over the past decade, in-hospital cardiac arrest continues to be associated with poor prognosis. This has led to the development of rapid response systems, hospital-wide efforts to improve patient outcomes by centering on prompt identification of decompensating patients, expert clinical management, and continuous quality improvement of processes of care. The rapid response system may include cardiac arrest teams, which are centered on identification and treatment of patients with in-hospital cardiac arrest. However, few evidence-based guidelines exist to guide the formation of such teams, and the degree of their variation across the United States has not been well described.DesignDescriptive cross-sectional, internet-based survey.SettingCohort of preidentified clinicians involved in their hospital's adult rapid response system across the United States.SubjectsClinicians who had been identified by study team members using personal and professional contacts over a 7-month period from June 2018 to December 2018.InterventionsAn 80-item survey was developed by the investigators. It sought information on the afferent (identification and notification of providers) and efferent (response of providers to patient) limbs of the rapid response system, as well as management of patients post in-hospital cardiac arrest.Measurements and main resultsOne-hundred fourteen surveys were distributed. Of these, 109 (96%) were completed. Six were duplicates and were excluded, leaving a total of 103 surveys from 103 hospitals in 30 states. Seventy-six percent of hospitals were academic, 30% were large hospitals (> 750 inpatient beds), and 58% had large ICUs (> 50 ICU beds). We found wide variation in the structure and function in both the afferent and efferent limbs of the rapid response system. The majority of hospitals had a rapid response team and a cardiac arrest team. Most rapid response teams contained a provider, a critical care nurse, and a respiratory therapist. In hospitals with training programs in internal medicine, anesthesia, emergency medicine, or critical care, 45% of rapid response teams and 75% of cardiac arrest teams were led by trainees, with inconsistent attending presence. Targeted temperature management and coronary catheterization were widely used post in-hospital cardiac arrest, but indications varied considerably.ConclusionsWe have demonstrated substantial variation in the structure and function of rapid response systems as well as in management of patients during and after in-hospital cardiac arrest.

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Dataset Information

Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states.

Objectives

Design

Setting

Participants

Results

Conclusions

Publications

Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states.

Similar Datasets

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