Open AccessOutcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study
Author(s) -
Ken Junyang Goh,
Hui Zhong Chai,
Lit Soo Ng,
Joanna Phone Ko,
Deshawn Chong Xuan Tan,
Han L. Tan,
Constance Teo,
Ghee Chee Phua,
Qiao Li Tan
Publication year - 2021
Publication title -
annals, academy of medicine, singapore/annals of the academy of medicine, singapore
Language(s) - English
Resource type - Journals
ISSN - 0304-4602
DOI - 10.47102/annals-acadmedsg.2021238
Subject(s) - medicine , rapid response team , observational study , early warning score , odds ratio , psychological intervention , referral , emergency medicine , confidence interval , intensive care unit , prospective cohort study , intensive care medicine , family medicine , nursing
A second-tier rapid response team (RRT) is activated for patients who do not respondto first-tier measures. The premise of a tiered response is that first-tier responses by a ward teammay identify and correct early states of deterioration or establish goals of care, thereby reducingunnecessary escalation of care to the RRT. Currently, utilisation and outcomes of tiered RRTs remainpoorly described.Methods: A prospective observational study of adult patients (age ≥18 years) who required RRTactivations was conducted from February 2018 to December 2019.Results: There were 951 consecutive RRT activations from 869 patients and 76.0% patients had aNational Early Warning Score (NEWS) ≥5 at the time of RRT activation. The majority (79.8%) ofpatients required RRT interventions that included endotracheal intubation (12.7%), point-of-careultrasound (17.0%), discussing goals of care (14.7%) and intensive care unit (ICU) admission (24.2%).Approximately 1 in 3 (36.6%) patients died during hospitalisation or within 30 days of RRT activation.In multivariate analysis, age ≥65 years, NEWS ≥7, ICU admission, longer hospitalisation days at RRTactivation, Eastern Cooperative Oncology Group performance scores ≥3 (OR [odds ratio] 2.24, 95%CI [confidence interval] 1.45–3.46), metastatic cancer (OR 2.64, 95% CI 1.71–4.08) and haematologicalcancer (OR 2.78, 95% CI 1.84–4.19) were independently associated with mortality.Conclusion: Critical care interventions and escalation of care are common with second-tier RRTs.This supports the need for dedicated teams with specialised critical care services. Poor functional status,metastatic and haematological cancer are significantly associated with mortality, independent of age,NEWS and ICU admission. These factors should be considered during triage and goals of care discussion.Keywords: Clinical deterioration, critical care, intensive care, mortality, rapid response system, rapidresponse team