Promoting patient safety: the rapid medical response team.

CONTEXT Adverse events are estimated to affect up to 17% of hospitalized patients and to cause up to 98,000 patient deaths per year in the United States. Unexpected codes in hospitalized patients are one of the most significant adverse events, carrying a risk of death that is reported to range from 50% to 80%. OBJECTIVE The Rapid Medical Response Team (RMRT) was an initiative designed to reduce adverse events, specifically failure to rescue, leading to nonintensive care unit (nonICU) codes. This initiative was funded, as part of the Transforming Care at the Bedside (TCAB) program, by a grant from the Robert Wood Johnson Foundation. DESIGN To determine whether the RMRT had a significant impact on our nonICU code rate, we did a retrospective, noncohort comparison of 2004 (preRMRT) data with 2005 (postRMRT) data. MAIN OUTCOME MEASURES Our main outcome measures were nonICU codes, mortality rate, and unplanned patient transfers to the intensive care unit (ICU). RESULTS There was a decrease in the nonICU code rate per 1000 discharges from 1.90 in 2004 to 1.01 in 2005. Implementation of the RMRT correlates to a statistically significant decrease in the nonICU code rate (p = .018; relative risk, 0.53 [95% confidence interval, 0.31-0.91]). The nonICU mortality rate remained unchanged at 2.01%. The unplanned ICU transfer rate for 2005 was 47%. CONCLUSIONS Implementation of RMRTs can decrease nonICU code rates and the rate of unplanned ICU transfers. RMRTs can empower staff, enhance expertise and communication skills, and support a culture of safety.