Patient characteristics, interventions and outcomes of 1,151 rapid response team activations in a tertiary hospital: a prospective study.
Intern Med J. 2016 Sep 7;
Authors: White K, Scott IA, Bernard A, McCulloch K, Vaux A, Joyce C, Sullivan CM
BACKGROUND: The characteristics of mature contemporary rapid response systems (RRS) are unclear.
OBJECTIVES: To determine the patient characteristics, processes and outcomes, both in-hospital and post-discharge, of a well established RRS in a tertiary adult hospital.
METHODS: Prospective study of consecutive rapid response team (RRT) activations between July 1(st) and November 25(th) 2015. Variables included patient characteristics, timing, location and triggers of RRT activations, interventions undertaken, mortality and readmission status at 28-days post-discharge.
RESULTS: 1,151 RRT activations were analysed (69.1 per 1000 admissions), involving 800 patients of whom 81.5% were emergency admissions. 351 (30.5%) activations comprised repeat activations for the same patient. Most activations (723; 62.8%) occurred out of hours and 495 (43%) occurred within 48 hours of admission. Hypotension, decreased level of consciousness and oxygen desaturation were the most common triggers. Advanced life support was undertaken in less than 7%; 198 (17.2%) responses led to transfer to higher level care units. Acute resuscitation plans (ARPs) were noted for only 29.1% of RRT activations with 80.3% stipulating supportive care only. 103 (12.6%) patients died in hospital, equaling 14 deaths per 100 RRT activations. At 28 days, 150 (18.8%) patients had died, significantly more among those with multiple versus single RRT activations (24.9% vs 16.6%; OR 1.66, 95% CI 1.31 to 2.44; p = 0.013).
CONCLUSION: Relatively few RRT activations are associated with ARPs and most interventions during RRT responses are low level. The high rate of post-RRT deaths and transfers calls for prospective identification of such patients in targeting appropriate care.
PMID: 27600063 [PubMed - as supplied by publisher]