McGaughey et al.(2323 McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev. 2007;(3):CD005529.)
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Systematic review Studies published between 1996 and June 2006 Outcome: mortality Intervention: Introduction of early warning scores by RRT |
Mortality |
Reduction in mortality |
Only two studies were examined; did not conduct economic analyses |
Reduction in mortality |
Moderate |
Chan et al.(2424 Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med. 2010;170(1):18-26.)
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Systematic review and meta-analysis Studies published between 01 January 1950 and 31 November 2008 Outcome: mortality and cardiopulmonary arrest Intervention: Introduction of RRT |
Mortality Cardiac arrest |
RR 0.96 (95%CI 0.84 - 1.09) RR 0.66 (95%CI 0.54 - 0.80) |
Did not analyze data at the individual level; academic centers were used in most studies reviewed |
4% (95%CI -9 - 16) 0.34 (95%CI 0.20 - 0.46) |
Moderate |
Maharaj et al.(2525 Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19:254.)
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Systematic review and meta-analysis Studies published between 01 January 1990 and 31 November 2013 Outcome: mortality and cardiopulmonary arrest Intervention: Introduction of RRT |
Mortality Cardiac arrest |
RR 0.87 (95%CI 0.81 - 0.95) (p < 0.001) RR 0.65 (95%CI 0.61 - 0.70) (p < 0.001) |
Did not analyze data at the individual level |
13% (95%CI 5 - 19) 35% (95%CI 30 - 39) |
Moderate |
Salvatierra et al.(2626 Salvatierra G, Bindler RC, Corbett C, Roll J, Daratha KB. Rapid response team implementation and in-hospital mortality. Crit Care Med. 2014;42(9):2001-6.)
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Before-after study Adult patients Intervention: Introduction of medical emergency teams in 10 hospitals in Washington over 31 months, 235344 patients Control: 235718 patients before intervention |
Mortality |
RR 0.76 (95%CI 0.72 - 0.80) |
Used historical controls |
24% (95%CI 20 - 28) |
Low |
Ludikhuize et al.(2929 Ludikhuize J, Brunsveld-Reinders AH, Dijkgraaf MG, Smorenburg SM, de Rooij SE, Adams R, de Maaijer PF, Fikkers BG, Tangkau P, de Jonge E; Cost and Outcomes of Medical Emergency Teams Study Group. Outcomes Associated With the Nationwide Introduction of Rapid Response Systems in The Netherlands. Crit Care Med. 2015;43(12):2544-51.)
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Before-after study Adult patients Intervention: The implementation of RRS was divided into two phases. First, the MEWS (Modified Early Warning Score) and the SBAR communication tools were administered; then after 7 months, RRTs were implemented in 12 Dutch hospitals, 29560 admissions Control: 28298 admissions |
Mortality Cardiac arrest |
OR 0.80 (95%CI 0.64 - 1.00) OR 0.60 (95%CI 0.39 - 0.93) |
Used historical controls |
20% (95%CI 0 - 36) 40% (95%CI 7 - 61) |
Low |
Buist et al.(3434 Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324(7334):387-9.)
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Before-after study Adult patients in American hospitals with 300 beds Intervention: Introduction of rapid response teams Controls: historical, 19317 admissions |
Cardiac arrest |
OR 0.5 (95%CI 0.35 - 0.73) |
Used historical controls |
50% (95%CI 27 - 65) |
Low |
DeVita et al.(3535 DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL; Medical Emergency Response Improvement Team (MERIT). Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13(4):251-4.)
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Retrospective analysis of outcomes Adult patients in American hospitals with 622 beds Intervention: Introduction of objective criteria medical emergency team activation |
Cardiac arrest |
6.5 to 5.4/1000 |
Observational study; retrospective analysis with confounders that were difficult to control for |
16% |
Moderate |
Priestley et al.(3636 Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, et al. Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med. 2004;30(7):1398-404.)
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Clinical trial randomized by wards 16 wards in an 800-bed general hospital in England Outcome: mortality Intervention: Introduction of critical care service in wards |
Mortality |
OR 0.52 (95%CI 0.32 - 0.85) |
Few hospitals participated; Hawthorne effect; contamination of controls; problems with data collection |
48% (95%CI 15 - 68) |
Moderate |
Jones et al.(3737 Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, et al. Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care. 2005;9(6):R808-15.)
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Before-after study, analysis of three periods Adult patients in an Australian hospital with 400 beds Intervention: Introduction of medical emergency teams Controls: historical, 16246 admissions |
Cardiac arrest |
OR 0.47 (95%CI 0.35 - 0.62) |
Used historical controls; not randomized or blinded; only one hospital was evaluated; cardiac arrest reduction mechanism was not revealed |
53% (95%CI 38 - 65) |
Low |
Hillman et al.(3838 Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A; MERIT study investigators. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365(9477):2091-7. Erratum in Lancet. 2005;366(9492):1164.)
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Randomized trial Adult patients in 23 Australian hospitals Outcome: cardiopulmonary arrest and unexpected death Intervention: introduction of medical emergency teams Control: No introduction of medical emergency team |
Mortality Cardiac arrest |
OR 1.03 (95%CI 0.84 - 1.28) OR 0.94 (95%CI 0.79 - 1.13) |
Variations found between hospitals were higher than was anticipated by the researchers |
-3% (95%CI -28 - 16) 6% (95%CI -13 - 21) |
Moderate |
Dacey et al.(3939 Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35(9):2076-82.)
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Before-after study Adult patients in American hospitals with 350 beds Intervention: Introduction of rapid response teams Controls: historical |
Mortality Cardiac arrest |
2.82 to 2.35/100 hospitalizations (p < 0.001) 7.6 to 3.0/1000 hospitalizations (p < 0.001) |
Not randomized; Hawthorne effect |
16% (p < 0.001) 60% (p < 0.001) |
Low |
Chan et al.(4040 Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA. Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA. 2008;300(21):2506-13.)
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Prospective cohort Adult patients in an American hospital with 404 beds Intervention: Introduction of rapid response teams Controls: historical, 24193 admissions |
Mortality |
OR 0.95 (95%CI 0.81 - 1.11) |
Used historical controls, but adjusted for temporal trends; weak statistical power to identify differences in mortality |
5% (95%CI -11 - 19) |
Low |
Konrad et al.(4141 Konrad D, Jäderling G, Bell M, Granath F, Ekbom A, Martling CR. Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med. 2010;36(1):100-6.)
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Before-after study Adult patients Intervention: Introduction of medical emergency teams, 73825 patients Control: 203892 patients before intervention |
Mortality Cardiac arrest |
OR 0.90 (95%CI 0.84 - 0.97) OR 0.74 (95%CI 0.55 - 0.98) |
Used historical controls; delays in the team drive were not evaluated |
10% (95%CI 3 - 16) 26% (95%CI 2 - 45) |
Low |
Beitler et al.(4242 Beitler JR, Link N, Bails DB, Hurdle K, Chong DH. Reduction in hospital-wide mortality after implementation of a rapid response team: a long-term cohort study. Crit Care. 2011;15(6):R269.)
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Prospective cohort Adult patients in American hospitals with 809 beds Intervention: Introduction of rapid response teams Controls: historical, 77021 patients |
Mortality Cardiac arrest |
RR 0.82 (95%CI 0.69 - 0.98) RR 0.49 (95%CI 0.39 - 0.61) |
Used historical controls, but adjusted for temporal trends |
18% (95%CI 2 - 31) 51% (95%CI 39 - 61) |
Low |
Gonçales et al.(4343 Gonçales PD, Polessi JA, Bass LM, Santos GP, Yokota PK, Laselva CR, et al. Redução de paradas cardiorrespiratórias por times de resposta rápida. Einstein (São Paulo). 2012;10(4):442-8.)
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Before-after study Adult patients in Brazilian hospitals with 477 beds Intervention: Introduction of medical emergency teams Control: patients attended over the 19 months before intervention |
Mortality Cardiac arrest |
14.34/1000 after intervention 16.27 before (p < 0.001) 1.69/1000 hospitalizations 3.54 before (p < 0.001) |
Used historical controls; delays in the team drive were not evaluated |
11% (p < 0.001) 52% (p < 0.001) |
Low |