Clinical outcomes of patients seen by Rapid Response Teams: A template for benchmarking international teams.
Resuscitation. 2016 Jul 11;
Authors: Bannard-Smith J, Lighthall GK, Subbe CP, Durham L, Welch J, Bellomo R, Jones DA, Medical Emergency Teams: Hospital Outcomes in a Day (METHOD) study investigators
AIM: The study was developed to characterize short-term outcomes of deteriorating ward patients triggering a rapid response team (RRT), and describe variability between hospitals or groups thereof.
METHODS: We performed an international prospective study of Rapid Response Team (RRT) activity over a 7-day period in February 2014. Investigators at 51 acute hospitals across Australia, Denmark, the Netherlands, USA and United Kingdom collected data on all patients triggering RRT review concerning the nature, trigger and immediate outcome of RRT review. Further follow-up at 24hours following RRT review focused on patient orientated outcomes including need for admission to critical care, change in limitations of therapy and all cause mortality.
RESULTS: We studied 1188 RRT activations. Derangement of vital signs as measured by the National Early Warning Score (NEWS) was more common in non-UK hospitals (p=0.03). 24hr mortality after RRT review was 10.1% (120/1188). Urgent transfer to ICU or the operating theatre occurred in 24% (284/1188) and 3% (40/1188) of events, respectively. Patients in the UK were less likely to be admitted to ICU (31% vs 22%; p=0.017) and their median (IQR) time to ICU admission was longer [4.4 (2.0-11.8) vs 1.5 (0.8-4.4) hours; p<0.001]. RRT involvement lead to new limitations in care in 28% of the patients not transferring to the ICU; in the UK such limitations were instituted in 21% of patients while this occurred in 40% of non-UK patients (p< 0.001).
CONCLUSION: Among patients triggering RRT review, one in ten died within 24hours; one in four required ICU admission, and one in four had new limitations in therapy implemented. We provide a template for an international comparison of outcomes at RRT level.
PMID: 27417561 [PubMed - as supplied by publisher]