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Impact of proactive rounding by a rapid response team on patient outcomes at an academic medical center

Authors

  • Brad W. Butcher MD,

    Corresponding author
    1. Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California
    • Division of Hospital Medicine, Department of Medicine, University of California San Francisco, 521 Parnassus Ave, Room C443, Box 0532, San Francisco, CA 94143-0532
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    • Telephone: 415-476-2172; Fax: 415-476-3381

  • Eric Vittinghoff PhD,

    1. Department of Epidemiology and Biostatistics, Division of Biostatistics, University of California San Francisco, San Francisco, California
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  • Judith Maselli MSPH,

    1. Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California
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  • Andrew D. Auerbach MD, MPH

    1. Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California
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Abstract

BACKGROUND:

The impact of rapid response teams (RRT) on patient outcomes remains uncertain.

OBJECTIVE:

To examine the effect of proactive rounding by an RRT on outcomes of hospitalized adults discharged from intensive care.

DESIGN:

Retrospective, observational study.

SETTING:

Academic medical center.

PATIENTS:

All adult patients discharged alive from the intensive care unit (ICU) at the University of California San Francisco Medical Center between January 2006 and June 2009.

INTERVENTION:

Introduction of proactive rounding by an RRT.

MEASUREMENTS:

Outcomes included the ICU readmission rate, ICU average length of stay (LOS), and in-hospital mortality of patients discharged from the ICU. Data were obtained from administrative billing databases and analyzed using an interrupted time series (ITS) model.

RESULTS:

We analyzed 17 months of preintervention data and 25 months of postintervention data. Introduction of proactive rounding by the RRT did not change the ICU readmission rate (6.7% before vs 7.3% after; P = 0.24), the ICU LOS (5.1 days vs 4.9 days; P = 0.24), or the in-hospital mortality of patients discharged from the ICU (6.0% vs 5.5%; P = 0.24). ITS models testing the impact of proactive rounding on secular trends found no improvement in any of the 3 clinical outcomes relative to their preintervention trends.

CONCLUSIONS:

Proactive rounding by an RRT did not improve patient outcomes, raising further questions about RRT benefits. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine

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