Volume 202 - Issue 10
Rapid response systems
Author: Kenneth M Hillman
Med J Aust 2015; 202 (10): 523. || doi: 10.5694/mja14.01655
Published online: 1 June 2015
Published online: 1 June 2015
In reply: It's not overdependence, but a strong association of reduction in deaths and cardiac arrests with uptake of RRS
In reply: Many thanks to Buist for his comments. He is quite correct in pointing out that we used the wrong reference.1 The correct reference was another study showing that the mortality of patients subject to a rapid response system (RRS) was higher than that for patients in an intensive care unit.2 Our apologies for this error.
In relation to the criticality of RRS calls, the largest trial on RRSs showed that of over 2000 calls, only five did not require critical care interventions.3 Moreover, the greater the number of calls, the greater the reduction in deaths and cardiac arrests.4
The high number of potentially preventable deaths and cardiac arrests when the admitting team cared for seriously ill patients on the general wards was the reason why RRS teams are now operating in most Australian hospitals.
Finally, in our opinion, the reference used to demonstrate overdependence on the system5 does not, in fact, show overdependence but, instead, a strong association of a reduction in deaths and cardiac arrests with the gradual uptake of RRSs in New South Wales hospitals.
Competing interests
No relevant disclosures.
Acknowledgements
I am supported by NHMRC Project Grants AP10009916 and APP1020660.
References
- Buist M, Nguyen T, Moore G, et al. Association between clinical abnormal bedside observations and subsequent in-hospital mortality: a prospective study. Resuscitation 2004; 62: 137-141. 1
- ANZICS-CORE MET dose investigators. Mortality of rapid response team patients in Australia: a multicentre study. Crit Care Resusc 2013; 15: 273-278. 2
- Flabouris A, Chen J, Hillman K, et al; The MERIT study investigators from the Simpson Centre and the ANZICS Clinical Trials Group. Timing and interventions of emergency teams during the MERIT study. Resuscitation 2010; 81: 25-30. 3
- Chen J, Bellomo R, Flabouris A, et al; MERIT Study Investigators for the Simpson Centre; ANZICS Clinical Trials Group. The relationship between early emergency team calls and serious adverse events. Crit Care Med 2009; 37: 148-153. 4
- Chen J, Ou L, Hillman K, et al. Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion. Med J Aust 2014; 201: 167-170. lefthere