Public Policy

The latest research you need to know

RRT Implement-ation Doesn’t Affect Hospitalwide Code Rates or Mortality

Clinical question: Does the use of a rapid-response team (RRT) affect hospitalwide code rates and mortality?

Background: In the 100,000 Lives campaign, the Institute for Healthcare Improvement recommended that hospitals implement RRTs to help reduce preventable, in-hospital deaths. Studies have demonstrated that rates of non-ICU codes decrease after RRT implementation. It is unclear if this translates to changes in mortality rates.

Study design: Prospective cohort study of adult inpatients.

Setting: Saint Luke’s Hospital, a 404-bed tertiary-care academic hospital in Kansas City, Mo.

Synopsis: The hospital documented a total of 376 RRT activations. After RRT implementation, mean hospitalwide code rates decreased to 7.5 per 1,000 admissions from 11.2 per 1,000 admissions. This was not associated with a statistically significant reduction in hospitalwide code rates (adjusted odds ratio 0.76; 95% CI; 0.57-1.01; P=0.06). Secondary analyses noted lower rates of non-ICU codes (0.59; 95% CI, 0.40-0.89) compared with ICU codes (0.95; 95% CI; 0.64-1.43; P=0.03 for interaction). Finally, the RRT implementation was not associated with lower hospital-wide mortality (0.95; 95% CI; 0.81-1.11; P=0.52).

Secondary analyses also revealed few instances of RRT undertreatment or underutilization that may have affected the mortality numbers.

A limitation of this study is that it was slightly underpowered (78%) to detect a significant mortality difference. The findings also represent a single institution experience, and may not be generalized to other adult hospital settings or RRT programs.

Bottom line: Implementation of an RRT does not confer lower rates of hospital-wide code arrests or mortality.

Citation: Chan P, Khalid A, Longmore L, et al. Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA. 2008;300(21):2506-2513.

Short Takes

ROSUVASTATIN REDUCES CARDIOVASCULAR EVENTS IN OLDER ADULTS WITH NORMAL LDL, ELEVATED CRP LEVELS

In this industry-sponsored, randomized, placebo-controlled study, rosuvastatin decreased cardiovascular events in healthy men older than 50 and healthy women older than 60 with LDL levels ≤ 130 mg/dL but elevated CRP levels 2.0 mg/dL.

Citation: Ridker P, Danielson E, Fonseca F, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207.

GINKGO BILOBA DOES NOT DECREASE INCIDENCE OF DEMENTIA IN ADULTS 75 AND OLDER

Randomized placebo-control study of 3,069 adults 75 and older with no cognitive impairment found that ginkgo biloba did not decrease overall incidence of dementia or Alzheimer’s disease.

Citation: DeKosky S, Williamson J, Fitzpatrick A, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008;300(19):2253-2262.

INDIVIDUAL HAPPINESS PREDICTED BY HAPPINESS OF FAMILY MEMBERS

A prospective study from the Framingham Heart Study followed 4,793 participants from 1983 to 2003 and found participant happiness to be associated with the happiness of people in their social networks.

Citation: Fowler J, Christakis N. Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ. 2008;337:a2338.

STATIN ADMINISTRATION PRIOR TO CARDIAC SURGERY DECREASES INCIDENCE OF POSTOPERATIVE DELIRIUM

Analysis of prospectively collected data of 1,059 patients undergoing cardiac surgery with cardiopulmonary bypass at an academic hospital found that preoperative statin use reduced the odds of delirium by 46%.

Citation: Katznelson R, Djaiani G, Borger M, et al. Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery. Anesthesiology. 2009;110(1):67-73.

CERTAIN NSAIDS ASSOCIATED WITH A HIGHER RISK OF ACUTE KIDNEY INJURY

This prospective cohort study of Medicare beneficiaries compared acute renal injury among users of COX-2 inhibitors and other NSAIDS, demonstrating that use of indomethacin, ibuprofen, and rofecoxib resulted in the highest rates of renal injury.

Citation: Winkelmayer W, Waikar S, Mogun H, Solomon D. Nonselective and cyclooxygenase-2-selective NSAIDs and acute kidney injury. Am J Med. 2008;121:1092-1098.

LESS SLEEP INCREASES CORONARY CALCIFICATIONS

This prospective, cohort study found an inverse association between coronary artery calcifications on CT scan and sleep duration as measured by actigraphy; this association was independent of common confounders.

Citation: King C, Knutson K, Rathouz P, et al. Short sleep duration and incident coronary artery calcification. JAMA. 2008;300(24):2859-2866.

CIGARETTE SMOKING IMPARTS HIGHER RISK OF COLORECTAL CANCER

This meta-analysis showed a direct association between cigarette smoking and colorectal cancer incidence and mortality, suggesting that smoking should be used in patient-risk stratification in colorectal cancer screening.

Citation: Botteri E, Iodice S, Bagnardi V, et al. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300(23):2765-2778.

INACTIVITY AND DEPRESSION INCREASES RISK FOR CARDIOVASCULAR EVENTS

In this prospective study of outpatients with coronary heart disease, the association between depressive symptoms and future cardiovascular events was primarily explained by health behaviors, including physical inactivity.

Citation: Whooley M, de Jonge P, Vittinghoff E, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA. 2008;300(20):2379-2388.

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