Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards

Babith Mankidy; Christopher Howard; Christopher K Morgan; Kartik A Valluri; Bria Giacomino; Eddie Marfil; Prakruthi Voore; Yao Ababio; Javad Razjouyan; Aanand D Naik; James P Herlihy

doi:10.1371/journal.pone.0241816

Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards

PLoS One. 2020 Dec 1;15(12):e0241816. doi: 10.1371/journal.pone.0241816. eCollection 2020.

Authors

Babith Mankidy^{1

2}, Christopher Howard^{1

2}, Christopher K Morgan^{1

2}, Kartik A Valluri^{1

2}, Bria Giacomino^{1

2}, Eddie Marfil¹, Prakruthi Voore¹, Yao Ababio¹, Javad Razjouyan^{2

3}, Aanand D Naik^{1

2

3}, James P Herlihy^{1

2}

Affiliations

¹ Department of Medicine, Baylor College of Medicine, Baylor St Luke's Medical Center, Houston, Texas, United States of America.
² Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America.
³ Veterans Affairs Health Services Research & Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America.

Abstract

Purpose: This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates.

Methods: In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team.

Results: Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED.

Conclusion: Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Critical Care / methods
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / prevention & control*
Emergency Service, Hospital
Female
Heart Arrest / epidemiology
Heart Arrest / pathology
Heart Arrest / therapy*
Hospital Mortality
Hospital Rapid Response Team*
Humans
Male
Middle Aged

Grants and funding

This study was funded in part from Precision Medicine/Population Health initiative pilot grant for CH, CM, JR, and AN; the Institute for Clinical Translational Health at the Baylor College of Medicine for JR and AN. Additional support included resources and use of facilities at the Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center- CIN 13-413 for JR and AN. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.