Original Articles
Vol. 21 No. 1 (2025)
https://doi.org/10.4081/ecj.2025.13374

Effectiveness and safety of an emergency department-based rapid response system

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 15 November 2024
Accepted: 6 December 2024
Published: 3 February 2025
522
Views
266
Downloads
Rapid Response System; Medical Emergency Team; Emergency Department; Emergency Medicine; Difference in Differences

Authors

Fanny Delfanti
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Guido Bertolini
https://orcid.org/0000-0002-3101-4259
Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy.
Giovanni Nattino
Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy.
Giulia Acquistapace
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Daniela De Palma
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Piergiuseppe Ferrari
https://orcid.org/0009-0003-3478-7577
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Sara Martinenghi
https://orcid.org/0009-0004-3467-6196
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Stefano Maiandi
https://orcid.org/0000-0002-4772-0676
Healthcare Professions Directorate – ASST di Lodi, Lodi, Italy.
Marco Rossi
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Anna Lilia Ruocco
https://orcid.org/0009-0006-2612-1187
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Maria Teresa Spina
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Benedetta Chiodi
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.
Stefano Paglia
stefano.paglia@asst-lodi.it
Emergency Unit, Ospedale di Lodi, Lodi (LO), Italy.

Rapid Response Systems (RRSs) are designed to assist hospitalized patients who become unstable, aiming to address “failure to rescue” and prevent cardiac arrests. Despite global implementation, evidence of RRS effectiveness is controversial. This study evaluates the effectiveness and safety of an RRS at Maggiore Hospital in Lodi, Italy, focusing on the Medical Emergency Team (MET) organization. The RRS at Maggiore Hospital was established in 2017 using the National Early Warning Score (NEWS) for monitoring. The MET, consisting of an emergency physician and one nurse, operates from 8:00 PM to 8:00 AM. Data from 2014-2019, divided into PRE (2014-2016) and POST (2017-2019) periods, were analyzed. The primary outcomes were unplanned ICU transfers and in-hospital mortality. A difference-in-differences (DiD) design compared outcomes in MET and non-MET wards before and after RRS implementation. Hospitalizations were similar in the PRE and POST periods. A significant reduction in Intensive Care Unit (ICU) transfers was observed overall (0.26%, p=0.005), but not in mortality (0.10%, p=0.47). Both MET and non-MET wards showed reduced ICU transfers, but the decrease was statistically significant only in MET wards. DiD analysis showed no significant reductions in either ICU transfer (p=0.77) or mortality rates (p=0.15) between MET and non-MET wards. The RRS at Maggiore Hospital effectively reduced ICU transfers without increasing mortality, demonstrating its safety. The MET organization did not significantly impact ICU transfers compared to non-MET wards. Further studies should explore additional measures of clinical deterioration to fully assess the impact of RRS.

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Subbe CP, Bannard-Smith J, Bunch J, et al. Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems. Resuscitation 2019;141:1–12.
Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021;161:115–51.
Hodgetts TJ, Kenward G, Vlackonikolis I, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation 2002;54:115–23.
Winters BD, Pham JC, Hunt EA, et al. Rapid response systems: a systematic review. Crit Care Med 2007;35:1238–43.
Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006;34:2463–78.
The Joint Commission announces the 2009 National Patient Safety Goals and requirements. Jt Comm Perspect Jt Comm Accreditation Healthc Organ 2008;28:1, 11–5.
Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006;295:324–7.
Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet Lond Engl 2005;365:2091–7.
Savoia G, Bosco G, Cerchiari E, et al. SIAARTI - IRC recommendations for organizing responses to In-Hospital emergencies. Minerva Anestesiol 2007;73:533–53.
Ministero della Salute. Piano per il miglioramento del Sistema di emergenza/urgenza - Documento commissione urgenza-emergenza [Internet]. 2005. Available from: https://www.salute.gov.it/imgs/C_17_pubblicazioni_856_ulterioriallegati_ulterioreallegato_0_alleg.pdf
Jones M. NEWSDIG: The National Early Warning Score Development and Implementation Group. Clin Med Lond Engl 2012;12:501–3.
Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute llness severity in the NHS. Update report of a working party [Internet]. 2017 Dec [cited 2024 Apr 17]. Available from: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM Mon J Assoc Physicians 2001;94:521–6.
McGinley A, Pearse RM. A national early warning score for acutely ill patients. BMJ 2012;345:e5310.
Data Protection Working Party. Article 29. Opinion 05/2014 on Anonymisation Techniques [Internet]. 2014. Available from: https://ec.europa.eu/justice/article-29/documentation/opinion-recommendation/files/2014/wp216_en.pdf
R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2019. Available from: https://www.R-project.org/
Bristow PJ, Hillman KM, Chey T, et al. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 2000;173:236–40.
Buist MD, Moore GE, Bernard SA, et al. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002;324:387–90.
DeVita MA, Braithwaite RS, Mahidhara R, et al. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 2004;13:251–4.
Sandroni C, D’Arrigo S, Antonelli M. Rapid response systems: are they really effective? Crit Care 2015;19:104.
White K, Scott IA, Bernard A, et al. Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study. Intern Med J 2016;46:1398–406.

How to Cite



Effectiveness and safety of an emergency department-based rapid response system. (2025). Emergency Care Journal, 21(1). https://doi.org/10.4081/ecj.2025.13374
Copyright (c) 2025 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.