The effectiveness of a standardised rapid response system on the reduction of cardiopulmonary arrests and other adverse events among emergency surgical admissions

Aim: A standardised rapid response system (RRS), called the “Between-the-Flags” (BTF) program, was implemented across a large health jurisdiction in Australia in 2010. The impact of RRS on emergency surgical admissions is unknown. Methods: We linked the NSW Admitted Patient Data Collection (APDC) and the NSW Registry of Births, Deaths, and Marriages. We used a propensity score-based inverse-probability-weighting adjustment to estimated average treatment effects among treated subjects (prior-RRS hospitals vs prior-non-RRS hospitals) before the BTF implementation (2007–2008) and after (2010–2013). Results: Before BTF, prior-RRS hospitals had a lower rate of in hospital cardiopulmonary arrests (IHCA) (4.7 vs 7.8 per 1000 admissions, P < 0.001), a lower rate of IHCA related deaths (3.0 vs 4.4 per 1000 admissions, P = 0.03) compared with patients in prior-non-RRS hospitals. There were no significant differences in overall in-hospital mortality and 30-day mortality between the two cohorts. After BTF, there were no significant differences for IHCA (4.8 vs 5.5 per 1000 admissions, P = 0.081) and related death rates (2.4 vs 2.3 per 1000 admissions, P = 0.678) between the two cohorts. Hospital mortality, 30-day mortality improved across both prior-RRS and prior-non-RRS hospitals following the BTF implementation. Conclusion: BTF program was associated with a significant reduction in IHCA and IHCA deaths for emergency surgical patients in prior-non-RRS hospitals but not in the prior-RRS hospitals. The overall hospital and 30-day mortality improved in both cohorts after BTF.