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Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states
  1. Oscar J L Mitchell1,
  2. Caroline W Motschwiller1,
  3. James M Horowitz2,
  4. Laura E Evans3,
  5. Vikramjit Mukherjee3
  1. 1 Department of Internal Medicine, New York University School of Medicine, New York City, New York, USA
  2. 2 Division of Cardiology, New York University School of Medicine, New York City, New York, USA
  3. 3 Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York City, New York, USA
  1. Correspondence to Dr Oscar J L Mitchell; oscarmitchell{at}


Objectives To characterise the variation in composition, leadership, and activation criteria of rapid response and cardiac arrest teams in five north-eastern states of the USA.

Design Cross-sectional study consisting of a voluntary 46-question survey of acute care hospitals in north-eastern USA.

Setting Acute care hospitals in New York, New Jersey, Rhode Island, Vermont, and Pennsylvania.

Participants Surveys were completed by any member of the rapid response team (RRT) with a working knowledge of team composition and function. Participants were all Medicare-participating acute care hospitals, including teaching and community hospitals as well as hospitals from rural, urban and suburban areas.

Results Out of 378 hospitals, contacts were identified for 303, and 107 surveys were completed. All but two hospitals had an RRT, 70% of which changed members daily. The most common activation criteria were clinical concern (95%), single vital sign abnormalities (77%) and early warning score (59%). Eighty one per cent of hospitals had a dedicated cardiac arrest team.

RRT composition varied widely, with respiratory therapists, critical care nurses, physicians and nurse managers being the most likely to attend (89%, 78%, 64% and 51%, respectively). Consistent presence of critical care physicians was uncommon and both cardiac arrest teams and teams were frequently led by trainee physicians, often without senior supervision.

Conclusions As the largest study to date in the USA, we have demonstrated wide heterogeneity, rapid team turnover and a lack of senior supervision of RRT and cardiac arrest teams. These factors likely contribute to the mixed results seen in studies of RRTs.

  • epidemiology

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  • Contributors OJLM, LEE and VM designed the study. OJLM, CWM, JMH and VM collected and analysed the data. OJLM, CWM, JMH, LEE and VM wrote the manuscript and agree to its submission for publication. All authors were involved in the writing of the manuscript and have drafted, reviewed and approved the current version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was reviewed and approved by the New York University School of Medicine’s Office of Science and Research Institutional Review Board (i17-01584).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data will not be published publicly. Please contact Oscar Mitchell at if access to the original data is required.

  • Patient consent for publication Not required.

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