Rapid response team characteristics and death among surgical inpatients with treatable serious complications in a North Texas hospital council

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2009-12

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Abstract

In 1999, the Institute of Medicine estimated as many as 98,000 patients died each year in US hospitals as the result of medical errors. Five years later, another report estimated 195,000 people died unnecessarily. A recent study of patient safety in American hospitals concluded that 87% of Medicare deaths identified over a three-year period were "potentially preventable." The rapid response team (RRT) has been recommended as an effective strategy for reducing avoidable patient deaths as measured by patient safety indicator #4 (PSI#4), Death among surgical inpatients with treatable serious complications [formerly failure to rescue]. There is no research evidence to support the recommendation. The purpose of this exploratory research study was to describe RRT characteristics, determine RRT penetration, and measure PSI#4 (Death among surgical inpatients) rates among hospitals in a large metropolitan area hospital council. A retrospective, descriptive design was used during analysis of survey data collected from members of the hospital council and secondary analysis of administrative data submitted by the same hospitals to a regional data warehouse. All of the hospitals represented by survey submissions had implemented RRTs. The majority of teams was nurse-led and could be activated by a wide range of hospital staff and family members. The hospitals used evidence-based criteria for RRT activation. There was a downward trend in the regional PSI#4 rate from 2003 to 2008, which was not statistically significant, but may be considered clinically significant. Nurse administrators viewed RRTs as effectively supporting nursing care. This study provided a first look at RRTs in relation to an untested patient safety indicator that measured avoidable patient deaths. More research with a larger sample size with adequate power to support statistical analysis of differences in PSI #4 rates over time will provide evidence regarding relationships among hospital characteristics, RRT characteristics, and avoidable deaths among surgical inpatients.

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