No improvement in inpatient mortality associated with increase in emergency calls

Rates of emergency (or rapid-response) calls varied month to month from 9.21 to 30.69 per 1,000 discharges in one Australian hospital, and there was no association between call rates and inpatient mortality.

Increases in medical emergency (or rapid-response) calls were not associated with improvements in hospital mortality, an Australian study found.

Researchers conducted two retrospective analyses. The first included all 441,029 patients discharged from one hospital in Melbourne from January 2008 to June 2016. The second included all 3.3 million patients discharged from 15 hospitals in the state of Victoria from July 2010 to June 2015. Results were published by Critical Care Medicine on March 29.

In the first study, patients' median age was 61 years, 57.2% were men, and 0.70% died. Monthly emergency call rates varied between 9.21 and 30.69 per 1,000 discharges, with a median of 18.4 per 1,000 discharges. Being treated at the hospital during a month with a higher calling rate was not associated with any improvement in mortality, after adjustment for age, gender, emergency status, same-day admission, year of discharge, and comorbidities.

The second study confirmed the findings of the first. Its population also had a median age of 61 years; 51.4% were men, and the hospital mortality rate was 0.83%. Emergency call rates varied from 18.46 to 33.40 per 1,000 discharges, with a median of 25.75 per 1,000 discharges, and their frequency was not associated with mortality rates. The study authors noted that previous research has shown improvements in mortality with higher calling rates but that these studies failed to adjust for overall improvements in hospital mortality over time, patient factors, and case mix.

“The success of medical emergency or rapid response teams has led to an increasing number of calls in many hospitals. This increase has often occurred naturally but sometimes encouraged in the belief that increased calling rates lead to reduced mortality,” the authors wrote. The worldwide generalizability of their study is limited and it may need to be confirmed with local data, but the current results suggest that efforts to increase rapid-response call rates do not seem warranted, the authors said.