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To the Editor: In his Commentary, Dr Berwick¹ began by citing radical mastectomy for breast cancer as a historical example of "the hard-won victory of evidence over belief in medicine." However, he then seemed to reverse course when discussing a contemporary medical issue regarding implementation of rapid response teams for inpatients with deteriorating conditions.

Two systematic reviews have demonstrated no significant benefit of rapid response teams.^2-3 However, Berwick ignored this evidence when supporting implementation of rapid response teams based on "large, positive, accumulating experience of many hospitals . . . adapting rapid response." We believe that greater caution should be exercised in rejecting the evidence from clinical trials and systematic reviews in favor of hospital-based anecdotal evidence. Moreover, given limited resources, hospitals' widespread adoption of rapid response teams may limit evaluation or implementation of other interventions that may improve patient outcomes, including measures that are even further upstream in preventing patient harm, such as . . . [Full Text of this Article]

Eddy Fan, MD
eddy.fan@jhmi.edu

Dale M. Needham, MD, PhD
Johns Hopkins University
Baltimore, Maryland

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