Expansion of rapid response systems throughout the Veterans Affairs network can reduce morbidity

Aug 27 2010

Implementing a rapid response team to aid in managing "potentially unstable" patients has led to a sharp reduction in the rate of cardiac arrests at a U.S. Veterans Affairs (VA) hospital, reports a study in the September issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

The study also found a trend toward a lower rate of in-hospital deaths. "Our results suggest that further reductions in morbidity can be realized by expansion of rapid response systems throughout the Veterans Affairs network," according to the study by Dr. Geoffrey K. Lighthall of the VA Medical Center in Palo Alto, Calif.

'eTeam' Reduces Cardiac Arrests—and Possibly Deaths
The study evaluated the impact of a rapid response system, called the "eTeam," at VA Palo Alto in 2005. Rapid response systems consist of teams of physicians, including intensive care specialists and anesthesiologists, along with nurses and other health care professionals. Members of this "high capability medical emergency team" have special training in evaluating and treating patients in potentially unstable condition—for example, a sudden decrease in breathing or heart rate, a drop in blood pressure, or a change in neurological condition.

"Rapid Response teams are a new approach to quickly intervening when a patient in the hospital is deteriorating," explains Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. "The goal is to interrupt the downward spiral that typically precedes cardiopulmonary arrest (code blue)."

During the first two years, the eTeam was called into action a total of 378 times. The rate of cardiac arrests at VA Palo Alto decreased sharply during this time: from an average of 10.1 to 4.36 cardiac arrests per 1,000 patients, a reduction of 57 percent. The reduction was even greater, 64 percent, in patients undergoing surgery.

The hospital death rate also decreased after introduction of the rapid response team—by about 17 percent. However, because of an overall trend toward reduced mortality, it was impossible to say how much of this reduction was due to the eTeam.

Previous studies have shown that introducing rapid response teams can have significant benefits in hospitalized patients. However, most of those studies were performed at individual hospitals, making it difficult to generalize the results.

The VA hospital network is the largest integrated health care provider in the United States, largely providing free care to disabled veterans. Because it is a single hospital system serving a relatively consistent population, interventions that have benefits at one VA hospital are likely to produce similar results at other hospitals.

Based on their results, Dr. Lighthall and colleagues think even greater benefits would be possible if the eTeam were used to its fullest potential—they believe that medical staff may be reluctant to accept help from the rapid response team in some situations. "Larger cooperative studies within the VA system are needed to more definitively assess impacts on mortality," the researchers conclude.

"This study is part of the Veterans Administration's long history of highly innovative approaches to advancing patient safety," adds Dr. Shafer. "The VA model for rapid response teams could become the standard of care if a large VA cooperative study demonstrates that other hospitals see the same improvements in outcome demonstrated by Lighthall and his coauthors in this study."

SOURCE Anesthesia & Analgesia