• Marin H Kollef, Yixin Chen, Kevin Heard, Gina N LaRossa, Chenyang Lu, Nathan R Martin, Nelda Martin, Scott T Micek, and Thomas Bailey.
• Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri.
• J Hosp Med. 2014 Jul 1;9(7):424-9.

BackgroundEpisodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs.ObjectiveTo determine if real-time alerts sent to the rapid response team (RRT) improved patient care.DesignRandomized, controlled trial.SettingEight medicine units (Barnes-Jewish Hospital).PatientsFive hundred seventy-one patients.InterventionReal-time alerts generated by a validated deterioration algorithm were sent real-time to the RRT (intervention) or hidden (control).MeasurementsIntensive care unit (ICU) transfer, hospital mortality, hospital duration.ResultsICU transfer (17.8% vs 18.2%; odds ratio: 0.972; 95% confidence interval [CI]: 0.635-1.490) and hospital mortality (7.3% vs 7.7%; odds ratio: 0.947; 95% CI: 0.509-1.764) were similar for the intervention and control groups. The number of patients requiring transfer to a nursing home or long-term acute care hospital was similar for patients in the intervention and control groups (26.9% vs 26.3%; odds ratio: 1.032; 95% CI: 0.712-1.495). Hospital duration (8.4 ± 9.5 days vs 9.4 ± 11.1 days; P = 0.038) was statistically shorter for the intervention group. The number of RRT calls initiated by the primary care team was similar for the intervention and control groups (19.9% vs 16.5%; odds ratio: 1.260; 95% CI: 0.823-1.931).ConclusionsReal-time alerts sent to the RRT did not reduce ICU transfers, hospital mortality, or the need for subsequent long term care. However, hospital length of stay was modestly reduced.© 2014 Society of Hospital Medicine.

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