A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team

Abstract

Background: Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs.

Objective: To determine if real-time alerts sent to the rapid response team (RRT) improved patient care.

Design: Randomized, controlled trial.

Setting: Eight medicine units (Barnes-Jewish Hospital).

Patients: Five hundred seventy-one patients.

Intervention: Real-time alerts generated by a validated deterioration algorithm were sent real-time to the RRT (intervention) or hidden (control).

Measurements: Intensive care unit (ICU) transfer, hospital mortality, hospital duration.

Results: ICU transfer (17.8% vs 18.2%; odds ratio: 0.972; 95% confidence interval [CI]: 0.635-1.490) and hospital mortality (7.3% vs 7.7%; odds ratio: 0.947; 95% CI: 0.509-1.764) were similar for the intervention and control groups. The number of patients requiring transfer to a nursing home or long-term acute care hospital was similar for patients in the intervention and control groups (26.9% vs 26.3%; odds ratio: 1.032; 95% CI: 0.712-1.495). Hospital duration (8.4 ± 9.5 days vs 9.4 ± 11.1 days; P = 0.038) was statistically shorter for the intervention group. The number of RRT calls initiated by the primary care team was similar for the intervention and control groups (19.9% vs 16.5%; odds ratio: 1.260; 95% CI: 0.823-1.931).

Conclusions: Real-time alerts sent to the RRT did not reduce ICU transfers, hospital mortality, or the need for subsequent long term care. However, hospital length of stay was modestly reduced.