Hospital preventive teams not saving lives: study

CHICAGO Tue Dec 2, 2008 4:12pm EST

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CHICAGO (Reuters) - Special teams set up to spot patients at risk of having cardiac or respiratory arrests in U.S. hospitals do not save lives and may not be a good use of resources, researchers said on Tuesday.

The teams are not "crash" teams that swoop in to revive patients but rather experts in identifying people likely to suffer often-fatal cardiac or respiratory arrests, to save both lives and costs.

Dr. Paul Chan of the University of Missouri in Kansas City and colleagues studied whether such rapid response teams helped reduce hospital-wide incidents of cardiopulmonary arrest and death rates.

"It's not harming people but there is not a clear additional benefit," said Chan, whose study appears in the Journal of the American Medical Association.

Rapid response teams are one of six recommendations made by the non-profit Institute for Healthcare Improvement or IHI as part of a push to cut preventable deaths and improve quality.

The special multidisciplinary teams are devoted to quickly identifying at-risk patients and moving them into a higher level of care, such as the intensive care unit, where they can be better monitored.

Chan said hospitals have widely adopted this practice with little evidence to suggest they help save lives.

He and colleagues looked to see whether the adoption of such a team in 2005 helped prevent cardiac and respiratory arrests at Saint Luke's Hospital in Kansas City. They compared hospital records on 24,193 admissions before the teams were put in place and nearly 25,000 after they were put in place.

While they saw fewer efforts to revive patients from cardiac and respiratory arrest outside of the intensive care unit, the addition of the teams did not significantly reduce such efforts across the whole hospital.

Nor did they save more lives.

"Based on our sample size, there was not even a suggestion of a reduction of mortality at the level we would have hoped," Chan said in a telephone interview.

Chan said the teams may have resulted in more families issuing "Do Not Resuscitate" or DNR orders that prohibit hospital staff from taking life-saving measures, but they were not able to track this.

Dr. Don Goldmann, senior vice president at IHI, noted that the researchers did see an overall decline in the need to revive patients from cardiac and respiratory arrests, a sign the teams were effective. "Whether it was statistically significant was inconclusive," he said.

"Overall, we're still extremely encouraged and think this is a sensible and logical approach to reducing cardiac and respiratory arrests and avoiding unnecessary deaths," Goldmann said in a telephone interview.

Chan said a larger study in more hospitals might yet prove the teams benefit patients.

Until that time, he said, "hospitals should take a step back and consider whether the investment in personnel and resources are the best way to use what scarce resources there are for quality improvement."

(Editing by Maggie Fox)

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