Anesthesiologists May Edge Out Nurses for Rapid Response Outside the ICU

Hospital rapid-response teams led by anesthesiologists may do a better job at heading off medical crises in deteriorating patients outside the ICU versus nurse-led teams, a researcher said.

In a study that tracked in-hospital mortality at the Cleveland Clinic's main hospital from 2010-2012 (nurse-led rapid-response teams) and from 2012-2018 (anesthesiologist-led teams), 1,437 cardiac arrests and 7,727 deaths were identified, according to Faith Factora, MD, of the Cleveland Clinic.

There were declines in cardiac arrests (odds ratio 0.53, 97.5% CI 0.41-0.69, P<0.001) and deaths (OR 0.73, 97.5% CI 0.65-0.81, P<0.001) with anesthesiologist-led teams, which included a nurse, a respiratory therapist, and an acute care nurse practitioner in some cases, Factora reported at the American Society of Anesthesiologists (ASA) annual meeting, held virtually and in-person in San Diego.

While the findings are not definitive, and may be due to improved healthcare over time, the results suggest "that an anesthesiologist-led rapid response team could potentially result in better outcomes in hospitalized patients. With that being said, it is a resource-intensive proposition," Factora told MedPage Today. And she cautioned that "it's still difficult to say with absolute certainty whether in-hospital cardiac arrests or hospital mortality has decreased."

Hospitals began to create rapid-response teams in the late 2000s after the Institute of Healthcare Improvement suggested them as part of a medical safety initiative, she explained. They are designed to provide urgent care to deteriorating patients at risk of suffering a cardiac arrest outside the ICU.

"The rationale behind a rapid-response team was that, if we are able to decrease the number of cardiac arrests in hospitalized patients, it would hopefully decrease hospital mortality rates," Factora said. "The teams can range from one clinician, a physician or nurse, to a team of four to five clinicians, which could include one to two physicians, one to two nurses, a respiratory therapist, and a pharmacist. The composition of the team varies greatly from institution to institution, depending on what kind of resources the hospital has, or the types of patients the individual hospitals serve."

Factora said hospitals may adopt a similar approach to rapid-response teams if they have anesthesiologists available, or if their patient population is sick enough that would benefit from the teams.

But Constance S. Houck, MD, MPH, of Boston Children's Hospital and Harvard Medical School, told MedPage Today that "Nurse-led rapid response teams can be quite effective in the initial care of minor, short-lived events such as syncope." She added that "a critical care-trained physician, such as an anesthesiologist or critical care physician, is essential for coordinating and managing potentially life-threatening events, such as anaphylaxis, seizures, or cardiopulmonary compromise."

"Nurses in our institution are taught to co-lead events with the anesthesiologist who may be less familiar with the resources and personnel on a particular hospital ward or clinic," explained Houck, who was not involved in the study.

She cautioned that more research was needed to fully understand the best approach to the teams. "It is likely that improved monitoring over this time period may also have contributed to these improvements in outcomes, as well as the institution of hospital-led protocols that prioritize early response to clinical deterioration," Houck stated. "Many of these were instituted in this time period."

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