Use of a real-time, machine learning–enabled clinical deterioration prediction model combined with an automated rapid response team (RRT) activation could reduce inpatient mortality. The objective was to assess reduction in risk-adjusted inpatient mortality following implementation of the Epic Deterioration Index (EDI) combined with an automated RRT activation in a large regional health system.

We conducted a quasi-experimental, staggered cohort study using a pre- versus postimplementation design. The setting was a regional health system with 11 acute care hospitals including academic, community teaching, and nonteaching facilities. Participants included adult medical–surgical admissions with an EDI greater than or equal to 60 from October 1, 2022, to August 30, 2024. We evaluated the clinical impact of deploying real-time, targeted electronic health record (EHR) alerts and RRT push notifications; the primary outcome was risk-adjusted inhospital mortality.

The study included 23,132 patients. Mean age was 71.9 years, 51.6% were male, and 51.4% were non-Hispanic white. In total, 10,803 patients (46.7%) were preintervention and 12,329 (53.3%) were postintervention; 5746 postintervention encounters (46.6%) generated a push notification to the RRT, although not all resulted in RRT activation. The postintervention group compared with the preintervention group was associated with increased RRT activations (37.5% vs. 25.3%; absolute difference, 12.2 percentage points [95% confidence interval (CI), 11.0 to 13.4]; adjusted odds ratio, 1.74 [95% CI, 1.61 to 1.88]) and decreased unadjusted inhospital mortality (18.6% vs. 23.1%; absolute difference, −4.5 percentage points [95% CI, −5.6 to −3.5]), without a significant increase in escalations of care (1.1% vs. 1.0%; absolute difference, 0.1 percentage points [95% CI, −0.18 to 0.37]; adjusted odds ratio, 1.34 [95% CI, 0.97 to 1.85]). Risk-adjusted odds of inhospital mortality, accounting for age, comorbidities, hospital type, EDI score, and clustering at the hospital level were lower in the intervention group (adjusted odds ratio, 0.82 [95% CI, 0.74 to 0.91]).

Implementation of the EDI combined with RRT activation was associated with a reduction in risk-adjusted inpatient mortality across different types of hospitals in a large health system.