Rapid Response Events in Hospitalized Patients: Patient Symptoms and Clinician Communication.
J Pain Symptom Manage. 2017 Dec 07;:
Authors: Austin CA, Choudhury S, Lincoln T, Chang LH, Cox CE, Weaver MA, Hanson LC, Nelson JE, Carson SS
CONTEXT: Patients triggering Rapid Response Team (RRT) intervention are at high risk for adverse outcomes. Data on symptom burden of these patients does not currently exist and current symptom management and communication practices of RRT clinicians are unknown.
OBJECTIVES: We sought to identify the symptom experience of Rapid Response Team (RRT) patients and observe how RRT clinicians communicate with patients and their families.
METHODS: We conducted a prospective, observational study from August - December 2015. Investigators attending RRT events measured frequencies of symptom assessment, communication, and supportive behaviors by RRT clinicians. As the rapid response event concluded, investigators measured patient-reported pain, dyspnea, and anxiety using a numeric rating scale (NRS) of 0 (none) to 10 (most severe), with uncontrolled symptoms defined as NRS rating ≥4.
RESULTS: We observed a total of 52 RRT events. RRT clinicians assessed for pain during the event in 62% of alert patients, dyspnea in 38%, and anxiety in 21%. Goals of care were discussed during 3% of events and within 24 hours in 13%. For the primary outcome measure, at the RRT event conclusion, 44% of alert patients had uncontrolled pain, 39% had uncontrolled dyspnea, and 35% had uncontrolled anxiety.
CONCLUSIONS: Hospitalized patients triggering RRT events have a high degree of uncontrolled symptoms that are infrequently assessed and treated. Although these patients experience an acute change in medical status and are at high risk for adverse outcomes, goals of care discussions with RRT patients or families are rarely documented in the period following the events.
PMID: 29225117 [PubMed - as supplied by publisher]