Rapid response team and hospital mortality in hospitalized patients

“…In turn, this is associated with the development of several complications, 2 particularly cardio-respiratory compromise 2,3 and unplanned intensive care unit (ICU) admission. 9 The responding team of the RRS is referred to as the rapid response team (RRT). One such intervention is the rapid response system 5 (RRS).…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of rapid response team activations for hypotension in orthopaedic patients

Ramos

Zhang

Maher

et al. 2020

Internal Medicine Journal

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Background Hypotension following orthopaedic surgery has been associated with increased morbidity and mortality. Rapid response teams (RRT) review patients on hospital wards with hypotension. Aim To evaluate the epidemiology of hypotensive RRT activations in adult orthopaedic patients to identify contributing factors and areas for future quality improvement. Methods Timing of RRT activations, presumed causes of hypotension and associated treatments were assessed. Results Among 963 RRT activations in 605 patients over 3 years, the first calls of 226 of 605 patients were due to hypotension, and 213 (94.2%) of 226 had sufficient data for analysis. The median age was 79 (interquartile range 66–87) years; 58 (27.2%) were male, and comorbidities were common. Most (68%) surgery was emergent, and 75.1% received intraoperative vasopressors for hypotension. Most activations occurred within 24 h of surgery, and hypovolaemia, infection and arrhythmias were common presumed causes. Fluid boluses occurred in 173 (81.2%), and the time between surgery and RRT activation was 10 (4.0–26.5) h. in cases where fluid boluses were given, compared with 33 (15.5–61.5) h. where they were not (P < 0.001). Blood transfusion (30, 14.1%) and withholding of medications were also common. Hospital mortality was 8.5% (18), and 13.6% (29) were admitted to critical care at some stage. In‐hospital death was associated with older age, functional dependence, arrhythmia and presumed infection. Conclusions Hypotension‐related RRT calls in orthopaedic patients are common. Future interventional studies might focus on perioperative fluid therapy and vaso‐active medications, as well as withholding of anti‐hypertensive medications preoperatively.

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“…In a recent article in Intensive Care Medicine, Jung and colleagues retrospectively analysed patients' outcomes after RRT implementation in one hospital (RRT hospital) and compared these to outcomes from three other hospitals (non-RRT hospitals) in the south of France [14]. In essence, the authors replicated a system that was developed 25 years ago and recommended by current resuscitation guidelines [15].…”

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Finally time for rapid response systems to be well MET in Europe?

Skrifvars

Martín‐Loeches²

2016

Intensive Care Med

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Time is life. In medicine there are many "time-dependent" diseases: sepsis and cardiac arrest to name but two [1,2]. In order to improve patient outcome, it is imperative to define and characterize hospital workflows to facilitate good process of care. Several factors need to be synchronized, including coordination between different departments in the hospital [3]. Early communication and a multidisciplinary approach can dramatically change the management of patients. The goal of modern intensive care medicine is to optimize and maximize quality of patient care. It is desirable to foster an overview of the process of critical care and base it on clinical need of patients and less on hospital location. Clinical management and monitoring of severely ill patients before admission to intensive care units (ICU) have frequently been shown to be suboptimal [4,5]. Delays in patient admission to ICU are associated with a longer hospital stay and worse outcome. Recently, Harris et al. prospectively analysed the outcome of a large UK population from 48 hospitals and concluded that the deteriorating ward patient has a high short-term mortality; however, with early ICU admission an impressive 50 % reduction of 90-day mortality is possible [6].Clinical conditions at risk are usually preceded by pathophysiological alterations that are both detectable and preventable. As early as the late 1990s, patient-atrisk teams, medical emergency teams (METs) or rapid response teams (RRT) were created to early detect patients at risk on general wards [7]. In the USA, the Institute for Healthcare Improvement (IHI) recommended, more than 10 years ago, that hospitals should implement RRTs and/or METs for the identification of non-ICU patients at risk of deterioration [8,9].Meta-analyses, including 30 before-after studies, cohort studies and cluster randomized trials found that implementation of an RRT/MET is associated with a reduction in non-ICU cardiopulmonary arrests but the effect on hospital mortality is less clear [10,11]. In the UK, early warning scores (EWS) based on "track and trigger" systems have for several years been used to flag and alert patients at risk and develop a rapid response by in-hospital teams with critical care skills to stabilize patients and expedite admission to ICU [12].Thus far the evidence on MET/RRT adoption has mainly originated from outside continental Europe [13]. In a recent article in Intensive Care Medicine, Jung and colleagues retrospectively analysed patients' outcomes after RRT implementation in one hospital (RRT hospital) and compared these to outcomes from three other hospitals (non-RRT hospitals) in the south of France [14]. In essence, the authors replicated a system that was developed 25 years ago and recommended by current resuscitation guidelines [15]. The study showed an impressive decrease in hospital mortality in the hospital with RRT implementation. There are not many interventions in ICU that can be attributed to a similar decrease in mortality and the authors should be congratulated for s...

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Rapid response team and hospital mortality in hospitalized patients

Abstract: In the present retrospective study, implementation of an intensivist-led RRT along with educational modules, publicity and bedside simulation-based training was associated with a significant decrease in unexpected and overall mortality of inpatients.

Cited by 108 publications

References 32 publications

Erfaringer med mobile intensivsykepleiere (MIS)

Erfaringer med mobile intensivsykepleiere (MIS)

Characteristics and outcomes of rapid response team activations for hypotension in orthopaedic patients

Finally time for rapid response systems to be well MET in Europe?

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