• Amit Kansal and Ken Havill.
• John Hunter Hospital, Newcastle, NSW, Australia. Amit.kansal@hnehealth.nsw.gov.au
• Crit Care Resusc. 2012 Mar 1; 14 (1): 38-43.

ObjectiveTo determine the impact on call characteristics and patient outcomes since the implementation of a two-tiered rapid-response system along with new observation charts and calling criteria.Design And SettingA retrospective before-and-after study in an Australian tertiary referral hospital.ParticipantsConsecutive adult patients (_18 years), who had a rapid-response call between June and October 2009 ("before") and between June and October 2010 ("after").Main Outcome MeasuresIncidence of "serious adverse events" (cardiac arrests, unexpected deaths, and unplanned intensive care unit/high-dependency unit [HDU] admissions); subsequent illness severity and ICU/HDU and hospital mortality and length of stay; episodes of repeat calls for the same patient, time since admission and treatment limitation/ not-for-resuscitation order profiles.ResultsStatistically significant increase in number of rapid response calls from 14.3 to 21.2 per 1000 hospital admissions before and after, respectively (P < 0.001); this was associated with a 16% decrease in composite serious adverse events (not significant). There were no significant differences in the number of unplanned ICU/HDU admissions, admission severity scores and subsequent ICU/HDU and hospital mortality and length of stay. There was a significant increase in number of calls for patients who were admitted to hospital within 24 hours (2.5 v 4.7 per 1000 hospital admissions before and after, respectively; P < 0.05) and for patients who were transferred from acute care areas within 24 hours (3.7 v 6.2 per 1000 hospital admissions before and after, respectively; P < 0.05). There was a significant increase in number of repeat calls for the same patient (1.6 v 4.2 per 1000 hospital admissions before and after, respectively; P < 0.001); this was associated with higher mortality compared with single review in the after period (35.8% v 18.5%, respectively; P = 0.005).ConclusionsImplementation of a two-tiered rapid-response system and new observation charts and calling criteria increased the number of rapid-response calls with a nonsignificant trend towards a decreased incidence of serious adverse events. Further improvements in care of hospitalised patients may be possible by preventing repeat calls or calls within 24 hours of hospital admission and discharge from acute care areas.

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