Association Between Activation of a Rapid Response Team and Outcomes of Sepsis in General Wards: A Nationwide Observational Study Using the Japanese Intensive Care Patient Database.

Abstract

Sepsis and septic shock require prompt intervention to improve outcomes. A rapid response team (RRT) system facilitates early recognition and management, including transfer to the ICU, but its impact on clinical outcomes remains unclear. This study assessed the association between RRT activation and clinical outcomes in septic patients initially managed in general wards, in a cohort of predominantly tertiary care hospitals in Japan. Secondary analysis of prospectively collected data from the Japanese Intensive Care PAtient Database (JIPAD) for the fiscal years 2017-2022. A multicenter study using the JIPAD, which includes 324,037 patients across 95 ICUs in Japan. We identified 3883 adult patients admitted to the ICU with sepsis or septic shock after initial management in a general ward. The patients were divided into those in whom the RRT was activated before ICU admission (the RRT group) and those in whom it was not (the control group). The primary outcome was in-hospital mortality. Secondary outcomes included rate of discharge to home, ICU mortality, length of hospital stay, and length of ICU stay. All outcome analyses were performed after stabilized inverse probability of treatment weighting using generalized estimating equations to account for clustering at the hospital level. There was no statistically significant difference in-hospital mortality between the RRT group ( n = 850) and the control group ( n = 3033; 38.6% vs. 37.1%; risk difference, 1.4%; 95% CI, -2.8% to 5.6%; p = 0.51). No significant differences were observed in secondary outcomes. In this nationwide study of septic patients requiring ICU admission, RRT activation was not associated with improvement of in-hospital mortality or other clinical outcomes. Despite the widespread implementation of RRTs, their impact on outcomes of sepsis in well-resourced healthcare systems such as Japan remains uncertain.