{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:52:19Z","timestamp":1788839539688,"version":"build-2803163510"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Purpose<\/jats:title><jats:p>This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0241816","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T20:38:49Z","timestamp":1606855129000},"page":"e0241816","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":22,"title":["Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2467-5024","authenticated-orcid":true,"given":"Babith","family":"Mankidy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Howard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K.","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartik A.","family":"Valluri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-9897","authenticated-orcid":true,"given":"Bria","family":"Giacomino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddie","family":"Marfil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakruthi","family":"Voore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Ababio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javad","family":"Razjouyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aanand D.","family":"Naik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Herlihy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"issue":"6","key":"pone.0241816.ref001","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1056\/NEJM199102073240604","article-title":"Incidence of adverse events and negligence in hospitalized patients: Results of the harvard medical practice study I","volume":"324","author":"TA Brennan","year":"1991","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0241816.ref002","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1056\/NEJM199102073240605","article-title":"The nature of adverse events in hospitalized patients: Results of the harvard medical practice study II","volume":"324","author":"LL Leape","year":"1991","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0241816.ref003","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1046\/j.1445-5994.2001.00077.x","article-title":"Antecedents to hospital deaths","volume":"31","author":"KM Hillman","year":"2001","journal-title":"Intern Med J"},{"issue":"6","key":"pone.0241816.ref004","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1378\/chest.98.6.1388","article-title":"Clinical antecedents to in-hospital cardiopulmonary arrest","volume":"98","author":"RMH Schein","year":"1990","journal-title":"Chest"},{"key":"pone.0241816.ref005","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.resuscitation.2015.08.016","article-title":"The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest","volume":"98","author":"LW Andersen","year":"2016","journal-title":"Resuscitation"},{"issue":"1","key":"pone.0241816.ref006","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5694\/j.1326-5377.1999.tb123492.x","article-title":"Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. 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