A rapid response system (RRS) may have limited effectiveness when inpatient providers fail to recognize signs of early patient decompensation. We evaluated the impact of an electronic medical record (EMR)-based alerting dashboard on outcomes associated with RRS activation. We used a repeated treatment study in which the dashboard display was successively turned on and off each week for ten 2-week cycles over a 20-week period on the inpatient acute care wards of an academic medical center. The Rapid Response Team (RRT) dashboard displayed all hospital patients in a single view ranked by severity score, updated in real time. The dashboard could be seen within the EMR by any provider, including RRT members. The primary outcomes were the incidence rate ratio (IRR) of all RRT activations, unexpected ICU transfers, cardiopulmonary arrests and deaths on general medical-surgical wards (wards). We conducted an exploratory analysis of first RRT activations. There were 6736 eligible admissions during the 20-week study period. There was no change in overall RRT activations (IRR = 1.14, p = 0.07), but a significant increase in first RRT activations (IRR = 1.20, p = 0.04). There were no significant differences in unexpected ICU transfers (IRR = 1.15, p = 0.25), cardiopulmonary arrests on general wards (IRR = 1.46, p = 0.43), or deaths on general wards (IRR = 0.96, p = 0.89). The introduction of the RRT dashboard was associated with increased initial RRT activations but not overall activations, unexpected ICU transfers, cardiopulmonary arrests, or death. The RRT dashboard is a novel tool to help providers recognize patient decompensation and may improve initial RRT notification.
Keywords: Electronic alerts; Electronic dashboards; Medical early warning score; Rapid response systems; Situational awareness.