Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study

Abstract

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.

Derivation and validation of a risk score for predicting mortality among inpatients following rapid response team activation

“…In deriving the tool, we did not exclude patients with documented NFR orders on the basis that less than a third of patients in our cohort had documented acute resuscitation plans (ARPs) at the time of RRT activation,8 similar to that noted in other studies 22. In the absence of ARPs on all patients, it is impossible to predict a priori which patients will be subsequently managed with palliative intent and assigned NFR and to whom application of the tool may be irrelevant.…”

“…Annualising the data from our original cohort study,8 the study hospital had 2762 RRT activations involving 1920 individuals, of which 361 (18.8%) would have deteriorated and died within 28 days. Our model could potentially identify more than 80% of the 960 patients for whom more aggressive care following RRT activation could prevent potential failures to rescue while avoiding wasting limited resources in providing equivalent care to other patients at much lower risk.…”

“…This study used data collected prospectively on 800 patients admitted to Princess Alexandra Hospital (PAH), a 640-bed tertiary hospital in Brisbane, Australia, and who were subject to 1151 RRT activations in wards outside of ICUs over a 5-month period from 1 July to 25 November 2015 and were followed up to 28 days following the only or last RRT activation 8. In brief, the RRT was available 24 hours a day, 7 days a week, and activations were triggered by single parameters comprising: threatened airway, systolic blood pressure <90 mm Hg, heart rate >140 or<40 beats per minute, oxygen saturations on pulse oximetry <90%, respiratory rate >36 or <8 per minute, decrease in Glasgow Coma Scale by 2 points, prolonged or repeated seizures or any staff concerns.…”

“…Despite this poor prognosis, the majority of actions performed by rapid response teams (RRTs) are non-life-saving interventions 4 7. In a recent Australian analysis of 1151 RRT activations in a tertiary hospital, less than 7% involved urgent advanced life support8 and less than 2% involved cardiorespiratory resuscitation. Nonetheless, 19% of patients died by 28 days and 17% required transfer to higher level care units.…”

Treatment of hypertension in older people

“…While fixed‐dose combinations may make antihypertensive dosing easier, they impose limitations when seeking to make temporary adjustments in therapy. In the hospitalised population, hypotension is the most common precipitant for a rapid response call, although the contribution of BP lowering medication to this problem is uncertain. There may be a need to alter background medication in the context of such intercurrent events.…”