PA-led rapid response team beneficial

General

Clinical Question:
Does a rapid response team led by a physician assistant reduce the rates of in-hospital cardiac arrest, unplanned transfers to the intensive care unit, and in-hospital mortality?

Bottom Line:
A rapid response team led by a trained physician assistant (PA) in a community hospital lowered rates of in-hospital cardiac arrest, unplanned intensive care unit (ICU) admissions, and in-hospital mortality. (LOE = 1b)

Reference:
Dacey MJ, Mirza ER, Wilcox V, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med 2007;35:2076-2082.  [PMID:17855821]

Study Design:
Cohort (prospective)

Setting:
Inpatient (ward only)

Synopsis:
This 350-bed community hospital developed a rapid response system (RRS) using a team consisting of a PA leader with a critical care nurse and a respiratory therapist. All PAs received intensive training in airway management and ICU skills. Those responsible for activating the RRS were staff nurses, physicians, Pas, and respiratory therapists who had also undergone RRS training. The rates of in-hospital cardiac arrest, unplanned ICU transfers, and in-hospital mortality using the RRS were compared with a five-month period prior to implementation. Over the 13-month study period, the rapid response team (RRT) was activated 344 times. The rate of cardiac arrest decreased during the study period from 7.6 to 3.0 arrests per 1000 discharges per month and unplanned ICU admissions were reduced from 45% to 29%. Overall in-hospital mortality decreased from 2.8% in the year prior to implementing the RRS to 2.3% after the RRS was in place. The RRT was also responsible for changing the resuscitation status in 35 patients. Although the hospital hired 2 additional PAs and dedicated 1 ICU nurse per shift to the team, a cost savings of approximately $5000 per arrest was estimated, and they avoided 94 cardiac arrests per year. Although limited by lack of randomization, this study suggests that trained mid-level health care providers can effectively serve in the role of an RRT leader.

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