# Assessing the Impact of a Rapid Response Team on Code Blue Incidents and Hospital Mortality Rate: Evidence From a Tertiary Care Hospital in India

## TL;DR

This study shows that implementing a Rapid Response Team in an Indian hospital reduced in-hospital deaths over time, though effects on other outcomes were not significant.

## Contribution

The study provides evidence of RRT effectiveness in a resource-limited setting, where such data is scarce.

## Key findings

- In-hospital mortality decreased from 3.7% to 2.9% after RRT implementation.
- Interrupted time series analysis showed a month-on-month decline in mortality post-intervention.
- Code Blue events and unplanned MICU transfers did not show statistically significant changes.

## Abstract

Background: Rapid Response Teams (RRTs) are designed and implemented to identify and respond to early signs of clinical deterioration, to prevent in-hospital adverse events, particularly cardiopulmonary arrests. This multidisciplinary team aims to improve patient outcomes and reduce hospital mortality. Despite their widespread adoption in high-resource settings, evidence on the efficacy of RRTs in resource-limited environments remains limited.

Objective: The objective of this study was to evaluate the impact of implementing an RRT on patient outcomes in a tertiary care hospital in South India.

Methods: This study compared data from six months before (November 2022 to April 2023) and six months after (November 2023 to April 2024) starting RRT. Event rates were analyzed using unadjusted and adjusted Poisson regression for all three outcomes. In-hospital mortality was additionally assessed using logistic regression and interrupted time series analysis to evaluate trends over time.

Results: Among 24,568 hospital admissions, in-hospital mortality decreased from 3.7% to 2.9% post-RRT implementation (absolute difference: 0.71%; p = 0.002). Code Blue events declined from 2.3 to 1.5 per 1,000 admissions, and unplanned MICU transfers remained stable; however, these changes were not statistically significant. Unadjusted Poisson analysis showed a significant reduction in mortality (rate ratio: 0.81; 95% CI: 0.70-0.93; p = 0.003), though adjusted models showed no significant effects. Interrupted time series analysis demonstrated a significant month-on-month decline in mortality post-intervention (OR: 0.91; 95% CI: 0.83-0.99; p = 0.021), suggesting a gradual impact over time.

Conclusion: RRT implementation was associated with a significant reduction in in-hospital mortality, with evidence of a sustained downward trend over time. Effects on Code Blue events and MICU transfers were not statistically significant, warranting further evaluation in similar settings.