Effects of a rapid response system on quality of life: a prospective cohort study in surgical patients before and after implementing a rapid response system

• Main Authors: Simmes, Friede (Author), Schoonhoven, Lisette (Author), Mintjes, Joke (Author), Fikkers, Bernard G. (Author), van der Hoeven, Johannes G. (Author)
• Format: Article
• Language: English
• Published: 2013-05-01.
• Subjects: Article
• Online Access: Get fulltext; Get fulltext

 Background: the aim of a rapid response system (RRS) is to improve the timely recognition and treatment of ward patients with deteriorating vital signs The system is based on a set of clinical criteria that are used to assess patient's vital signs on a general ward. Once a patient is evaluated as critical, a medical emergency team is activated to more thoroughly assess the patient's physical condition and to initiate treatment. The medical emergency team included a critical care physician and a critical care nurse. Aim: to assess the effect of an RRS on health-related quality of life (HRQOL). Methods: prospective cohort study in surgical patients before and after implementing an RRS. HRQOL was measured using the EuroQol-5 dimensions (EQ-5D) and the EQ visual analogue scale (VAS) at pre surgery and at 3 and 6 months following surgery. Results: no statistical significant effects of RRS implementation on the EQ-5D index and EQ-VAS were found. This was also true for the subpopulation of patients with an unplanned intensive care unit admission. Regarding the EQ-5D dimensions, deterioration in the 'mobility' and 'usual activities' dimensions in the post-implementation group was significantly less compared to the pre-implementation group with a respective mean difference of 0.08 (p?=?0.03) and 0.09 (p?=?0.04) on a three-point scale at 6 months. Lower pre-surgery EQ-5D index and higher American Society of Anesthesiologists physical status (ASA-PS) scores were significantly associated with lower EQ-5D index scores at 3 and 6 months following surgery. Conclusions: implementation of an RRS did not convincingly affect HRQOL following major surgery. We question if HRQOL is an adequate measure to assess the influence of an RRS. Pre-surgery HRQOL- and ASA-PS scores were strongly associated with HRQOL outcomes and may have abated the influence of the RRS implementation