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Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study
Author(s) -
White K.,
Scott I. A.,
Bernard A.,
McCulloch K.,
Vaux A.,
Joyce C.,
Sullivan C. M.
Publication year - 2016
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13248
Subject(s) - rapid response team , medicine , emergency medicine , psychological intervention , confidence interval , odds ratio , prospective cohort study , resuscitation , acute care , tertiary care , intensive care medicine , health care , economics , economic growth , psychiatry
Background The characteristics of mature contemporary rapid response systems are unclear. Aim To determine the patient characteristics, processes and outcomes, both in‐hospital and post‐discharge, of a well‐established rapid response system in a tertiary adult hospital. Methods This is a prospective study of consecutive rapid response team ( RRT ) activations between 1 July and 25 November 2015. Variables included patient characteristics, timing, location and triggers of RRT activations, interventions undertaken, mortality and readmission status at 28 days post‐discharge. Results A total of 1151 RRT activations was analysed (69.1 per 1000 admissions), involving 800 patients, of whom 81.5% were emergency admissions. A total of 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 h 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 were noted for only 29.1% of RRT activations, with 80.3% stipulating supportive care only. A total of 103 (12.6%) patients died in hospital, equalling 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%; odds ratio 1.66, 95% confidence interval 1.31–2.44; P = 0.013). Conclusion Relatively few RRT activations are associated with acute resuscitation plans, and most interventions during RRT responses are low level. The high rate of post‐ RRT deaths and transfers to higher‐level care units calls for the prospective identification of such patients in targeting appropriate care.