Intensive Care Medicine

, Volume 42, Issue 4, pp 494–504 | Cite as

Rapid response team and hospital mortality in hospitalized patients

  • Boris Jung
  • Aurelien Daurat
  • Audrey De Jong
  • Gerald Chanques
  • Martin Mahul
  • Marion Monnin
  • Nicolas Molinari
  • Samir JaberEmail author
Seven-Day Profile Publication



Although rapid response systems are known to reduce in-hospital cardiac arrest rate, their effect on mortality remains debated. The present study aimed to evaluate the effect of implementing an intensivist-led rapid response team (RRT) on mortality in hospitalized patients.


An implementation of an intervention and a comparison with retrospective data analysis were performed in the four hospitals of Montpellier regional healthcare centre, in France. An intensivist-led RRT was implemented on a 24/7 basis along with educational modules, publicity and bedside simulation-based training in only one of the four hospitals from January 2012 to June 2012. A single activation criterion (heart rate below 40/min or above 140/min, systolic blood pressure below 80 mmHg, cardiac arrest, respiratory rate below 8/min or above 30/min, pulse oximetry below 90 % with O2 above 6 l/min, respiratory distress in a tracheotomised patient, respiratory arrest, coma or sudden change in level of consciousness, seizure) allowed any caregiver to directly contact the RRT using a dedicated cell phone number. Patients over 18 years admitted for more than 24 h in the medical-surgical wards from July 2010 to December 2011 (pre-RRT period) and from July 2012 to December 2013 (RRT period) were included. The main outcome was unexpected mortality. Analyses of data from one RRT hospital and three control hospitals (no RRT hospital) were performed.


RRT implementation was associated with a decrease in unexpected mortality rate in the hospital that implemented RRT (from 21.9 to 17.4 per 1000 discharges; p = 0.002). Reduction in unexpected mortality associated with RRT implementation could be estimated at 1.5 lives saved per week in the RRT hospital. In the three other hospitals, mortality rate was not significantly modified (from 19.5 to 19.9 per 1000 discharges; p = 0.69). Overall mortality decreased from 39.6 to 34.6 per 1000 discharges between the pre-RRT and RRT period in the RRT hospital (p = 0.012), but did not significantly change in the other hospitals. Patients in the RRT hospital were more frequently admitted to the intensive care unit (ICU) during the RRT period (45.8 vs 52.9 per 1000; p = 0.002), and their sequential organ failure assessment (SOFA) score upon ICU admission significantly decreased from 7 (4–10) to 5 (2–9); p < 0.001.


In the present retrospective study, implementation of an intensivist-led RRT along with educational modules, publicity and bedside simulation-based training was associated with a significant decrease in unexpected and overall mortality of inpatients.


Medical emergency team Rapid response team Cardiac arrest Patient safety 



We thank the nurses and physicians of the rapid response team of the ICU of Saint Eloi Hospital for their work in collecting data and their support in the RRT implementation. The authors also acknowledge Valerie Maccioce for the English editing, David Demoulin for his invaluable help and support in extracting data from the hospital database and the Montpellier University Hospital Communication Department for having designed the flyers and poster.

Compliance with ethical standards

Conflicts of interest

Boris Jung reports personal fees from Merck (Whitehouse station, NJ) and Astellas (Tokyo, Japan) not related to the present study. Aurelien Daurat, Audrey De Jong, Martin Mahul, Marion Monnin, Gerald Chanques and Nicolas Molinari have nothing to disclose. Samir Jaber reports personal fees from Maquet, Draeger, Hamilton Medical and Fisher Paykel not related to the present study.


This study was supported by the University Hospital of Montpellier.


  1. 1.
    Nolan JP, Soar J, Cariou A et al (2015) European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015. Resuscitation 95:202–222. doi: 10.1016/j.resuscitation.2015.07.018 CrossRefPubMedGoogle Scholar
  2. 2.
    Brennan TA, Leape LL, Laird NM et al (1991) Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376. doi: 10.1056/NEJM199102073240604 CrossRefPubMedGoogle Scholar
  3. 3.
    Zegers M, de Bruijne MC, de Keizer B et al (2011) The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Saf Surg 5:13. doi: 10.1186/1754-9493-5-13 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Jones D, Bellomo R, DeVita MA (2009) Effectiveness of the medical emergency team: the importance of dose. Crit Care 13:313. doi: 10.1186/cc7996 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    England K, Bion JF (2008) Introduction of medical emergency teams in Australia and New Zealand: a multicentre study. Crit Care 12:151. doi: 10.1186/cc6902 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Institute for Healthcare Improvement (2014) Overview. Accessed 9 Oct 2014
  7. 7.
    Hilton AK, Jones D, Bellomo R (2013) Clinical review: the role of the intensivist and the rapid response team in nosocomial end-of-life care. Crit Care 17:224. doi: 10.1186/cc11856 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Salvatierra G, Bindler RC, Corbett C et al (2014) Rapid response team implementation and in-hospital mortality. Crit Care Med 42:2001–2006. doi: 10.1097/CCM.0000000000000347 CrossRefPubMedGoogle Scholar
  9. 9.
    von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577. doi: 10.7326/0003-4819-147-8-200710160-00010 CrossRefGoogle Scholar
  10. 10.
    Benchimol EI, Smeeth L, Guttmann A et al (2015) The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med 12:e1001885. doi: 10.1371/journal.pmed.1001885 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cummins RO, Chamberlain D, Hazinski MF et al (1997) Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital “Utstein style”. Circulation 95:2213–2239CrossRefPubMedGoogle Scholar
  12. 12.
    Devita MA, Bellomo R, Hillman K et al (2006) Findings of the first consensus conference on medical emergency teams. Crit Care Med 34:2463–2478. doi: 10.1097/01.CCM.0000235743.38172.6E CrossRefPubMedGoogle Scholar
  13. 13.
    de Jong A, Molinari N, de Lattre S et al (2013) Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study (the NURSE-DO project). Crit Care 17:R74. doi: 10.1186/cc12683 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Taylor MJ, McNicholas C, Nicolay C et al (2014) Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf 23:290–298. doi: 10.1136/bmjqs-2013-001862 CrossRefPubMedGoogle Scholar
  15. 15.
    Chan PS, Khalid A, Longmore LS et al (2008) Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA 300:2506–2513. doi: 10.1001/jama.2008.715 CrossRefPubMedGoogle Scholar
  16. 16.
    Subbe CP, Kruger M, Rutherford P, Gemmel L (2001) Validation of a modified early warning score in medical admissions. QJM 94:521–526CrossRefPubMedGoogle Scholar
  17. 17.
    Jaber S, Jung B, Corne P et al (2010) An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med 36:248–255. doi: 10.1007/s00134-009-1717-8 CrossRefPubMedGoogle Scholar
  18. 18.
    Haig KM, Sutton S, Whittington J (2006) SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 32:167–175CrossRefPubMedGoogle Scholar
  19. 19.
    ATIH (2015) MCO: Classification médico-économique. Accessed 13 Apr 2015
  20. 20.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefPubMedGoogle Scholar
  21. 21.
    Vincent JL, Moreno R, Takala J et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  22. 22.
    Hillman K, Chen J, Cretikos M et al (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097. doi: 10.1016/S0140-6736(05)66733-5 CrossRefPubMedGoogle Scholar
  23. 23.
    Al-Qahtani S, Al-Dorzi HM, Tamim HM et al (2013) Impact of an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. Crit Care Med 41:506–517. doi: 10.1097/CCM.0b013e318271440b CrossRefPubMedGoogle Scholar
  24. 24.
    Zhu B, Li Z, Jiang L et al (2015) Effect of a quality improvement program on weaning from mechanical ventilation: a cluster randomized trial. Intensive Care Med 41:1781–1790. doi: 10.1007/s00134-015-3958-z CrossRefPubMedGoogle Scholar
  25. 25.
    Sandroni C, Caricato A (2013) Are rapid response systems effective in reducing hospital mortality? Crit Care Med 41:679–680. doi: 10.1097/CCM.0b013e318275cb7d CrossRefPubMedGoogle Scholar
  26. 26.
    Priestley G, Watson W, Rashidian A et al (2004) Introducing critical care outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med 30:1398–1404. doi: 10.1007/s00134-004-2268-7 CrossRefPubMedGoogle Scholar
  27. 27.
    Hillman K, Chen J, Cretikos M et al (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097. doi: 10.1016/S0140-6736(05)66733-5 CrossRefPubMedGoogle Scholar
  28. 28.
    Chan PS, Jain R, Nallmothu BK et al (2010) Rapid response teams: a systematic review and meta-analysis. Arch Intern Med 170:18–26. doi: 10.1001/archinternmed.2009.424 CrossRefPubMedGoogle Scholar
  29. 29.
    McNeill G, Bryden D (2013) Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review. Resuscitation 84:1652–1667. doi: 10.1016/j.resuscitation.2013.08.006 CrossRefPubMedGoogle Scholar
  30. 30.
    Winters BD, Weaver SJ, Pfoh ER et al (2013) Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med 158:417–425. doi: 10.7326/0003-4819-158-5-201303051-00009 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Jones DA, DeVita MA, Bellomo R (2011) Rapid-response teams. N Engl J Med 365:139–146CrossRefPubMedGoogle Scholar
  32. 32.
    Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596. doi: 10.1097/01.CCM.0000217961.75225.E9 CrossRefPubMedGoogle Scholar
  33. 33.
    Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637. doi: 10.1097/CCM.0b013e31827e83af CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Boris Jung
    • 1
    • 2
  • Aurelien Daurat
    • 1
  • Audrey De Jong
    • 1
    • 2
  • Gerald Chanques
    • 1
    • 2
  • Martin Mahul
    • 1
  • Marion Monnin
    • 1
  • Nicolas Molinari
    • 3
  • Samir Jaber
    • 1
    • 2
    Email author
  1. 1.Intensive Care Unit, Department of Anesthesia and Critical Care MedicineUniversity of Montpellier, Saint Eloi Teaching HospitalMontpellierFrance
  2. 2.Centre National de la Recherche Scientifique (CNRS 9214), Institut National de la Santé et de la Recherche Medicale (INSERM U-1046)Montpellier UniversityMontpellierFrance
  3. 3.Department of StatisticsUniversity of Montpellier Lapeyronie HospitalMontpellierFrance

Personalised recommendations