Tuesday, March 21, 2006

Rapid Response Team

Tuesday March 21, 2006
Rapid Response Team / Medical Emergency Team

Overall impression and anecdotal experiences are in favor of Rapid Response Team. Also IHI recommends it as part of "
100,000 Lives Campaign". But unfortunately on scientific grounds we are still lacking absolute evidence for Rapid Response Team. Here we will give synopsis of 2 conflicting studies. Unfortunately again, its like comparing oranges to apples as second study comprised only of surgical patients.

23 hospitals in Australia were randomized to continue functioning as usual (n=11) or to introduce a RRT/MET system (n=12). The RRT was called only to 30% of patients who fulfilled the calling criteria.

Was it just an over active issue or a manifestation of poor pre-training ?.

The outcomes (cardiac arrests, unplanned ICU admissions and unexpected deaths) were analyzed. And the final conclusion was: although the call to RRT/MET system (3·1 vs 8·7 per 1000 admissions) was greatly increased, but does not substantially affect the incidence of cardiac arrest (1·64 vs 1·31 per 1000 admissions; p=0·736), unplanned ICU admissions (4·68 vs 4·19 per 1000 admissions; p=0·599), or unexpected death (1·18 vs 1·06 per 1000 admissions; p=0·752).

2. Bellomo and colleague's trial - effect of MET on postoperative morbidity and mortality rates: In the control period, there were 336 adverse outcomes in 190 patients, which decreased to 136 in 105 patients during the intervention period (relative risk reduction, 57.8%; p < .0001). These changes were due to significant decreases in the number of cases of respiratory failure, stroke, severe sepsis and acute renal failure (requiring renal replacement therapy). Emergency intensive care unit admissions were also reduced as well as postoperative deaths. Duration of hospital stay after major surgery decreased from a mean of 23.8 days to 19.8 days.

IHI's Rapid Response Team - getting started kit
SCCM's RRT/ MET forum

References: first popup overwrites second popup
Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial, MERIT study - The Lancet 2005; 365:2091-2097 - abstract available with free registration
Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates - Critical Care Medicine: Volume 32(4) April 2004 pp 916-921