Study: Rapid-response teams have limited impact on cardiac deaths

From Modern Healthcare:

Rapid-response teams do not appear to have a significant impact on reducing cardiac arrest or deaths in hospitals, according to a new study published in the Dec. 3 issue of the Journal of the American Medical Association.

Researchers studied the use of rapid-response teams consisting of intensive-care unit nurses and respiratory therapists at 404-bed St. Luke’s Hospital of Kansas City (Mo.), and their association with lower hospitalwide cardiopulmonary arrest and hospital mortality rates. Despite support from patient-safety advocates like the Institute for Healthcare Research for hospitals to use rapid-response teams, the researchers said they couldn’t determine a meaningful link between their use and fewer deaths.

The researchers conducted the study from Jan. 1, 2004 to Aug. 31, 2007, first recording cases in which patients coded or died for 18 months, then educating hospital staff about the use of rapid-response teams and implementing the teams for another 18-month period. Cardiac fatality rates after cardiopulmonary arrest were similar during both time periods—77.9% prior to implementing the teams and 76.1% after implementation. In addition, hospital death rates also were not significantly changed: There were 3.22 deaths per 100 admissions before the use of teams and 3.09 deaths per 100 admissions after, according to the study.

“We believe that this study provides important new insights regarding the effectiveness and limitations of rapid-response team intervention and raises critical questions about whether recommendations to disseminate rapid-response teams nationally are warranted without a demonstrable mortality benefit,” the researchers said in a written statement.

IOM stresses need to limit medical residents’ fatigue

From Modern Healthcare:

In order to enhance patient safety as well as physician training, the Institute of Medicine is calling for keeping the current 80-hour per week limit for medical residents; restricting residents to 16-hour daily shifts, unless a continuous five-hour sleep break is allowed; curbing residents’ off-hours “moonlighting” at other jobs; and providing for safe transport home in case a resident is too tired to drive safely.

The 324-page report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, also stated that current work-limit violations are underreported so more frequent and unannounced inspections by the Accreditation Council for Graduate Medical Education are needed. The report acknowledged that there are financial barriers to implementing further revisions to work-hour limits, and it included an estimate that the 80-hour limit, set in 2003, adds about $1.7 billion in extra labor costs annually as others must handle duties that had traditionally been performed by residents.

Citing the examples of 48- and 72-hour limits in Europe and New Zealand, respectively, the report concluded that it is not possible to determine the ideal workload for physicians in training and that the amount of duty hours may not be the greatest factor affecting quality of care. Nevertheless, it stated that there is much evidence that links fatigue to decreased performance so resident fatigue must be mitigated in order to reduce the conditions that lead to medical errors