Each year, more than 200,000 patients are affected by in-hospital cardiac arrest, which is associated with poor survival. Rapid response teams (RRTs), in which critical care experts evaluate patients with clinical deterioration, initiate lifesaving treatment, or transfer patients to a higher level of care, are increasingly relied on to prevent in-hospital cardiac arrest. Yet, although most acute care hospitals in the United States now have RRTs, their effectiveness hasn't been consistently demonstrated.

Researchers compared the organizational structure and function of RRTs in top-performing and non-top-performing hospitals for in-hospital cardiac arrest survival. They conducted semistructured interviews with 158 hospital staff members from nine hospitals involved in a national quality improvement program.

RRTs at top-performing hospitals (those in the highest quartile of risk-standardized survival rates for in-hospital cardiac arrest) differed from those at non-top-performing hospitals in four principal domains: team design and composition; surveillance of at-risk patients; empowerment of bedside nurses to activate rapid responses; and RRT collaboration with bedside nurses. At the top-performing hospitals, RRTs typically had dedicated staff with no competing responsibilities; the skills and experience to deal with emergencies; and collaborated with bedside nurses in the surveillance of at-risk patients, both during a rapid response and afterward, when they provided debriefing and education. Bedside nurses in these hospitals were empowered to call RRTs based on their experience and judgment, without fear of reprisal.

At non-top-performing hospitals, by contrast, RRTs were often formed ad hoc, and members had competing clinical responsibilities. These teams also tended to engage less with bedside nurses, who were concerned about the consequences of activating the RRT.

The authors note that the criterion used to designate top-performing hospitals was in-hospital cardiac arrest survival, whereas the goal of the RRT is to prevent in-hospital cardiac arrest, not necessarily improve survival. Also, owing to the study design, hospitals with exceptionally low rates of in-hospital cardiac arrest may have been inadvertently excluded.-KR