Rapid response team patients triaged to remain on ward despite deranged vital signs: missed opportunities?

Tirkkonen, Joonas; Kontula, Timo; Hoppu, Sanna

doi:10.1111/aas.12993

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…7 We have previously published two single centre trials investigating this subject and found that abnormal vital signs at the time of RRT arrival (whether classified as normal/abnormal according to hospital's 'track and trigger' criteria or the NEWS 20 ) were independently associated with worse outcome. 32,33 The present study confirms this observation in a large multicentre setting and contribute further specific observations across organ systems. Interestingly, RRThaemo patients were more likely to survive than RRT patients with no abnormal vital signs.…”

Section: Vital Signs Upon Rrt Arrivalsupporting

confidence: 89%

“…While most RRT studies have documented the RRT trigger reasons, data on the actual vital signs upon RRT arrival are sparsely reported. 7,32,33 The high fidelity RRTobs data captured in a structured manner by an experienced team with critical care skills warrant more study. Boniatti et al found that 30% of the RRT patients had normal vital signs upon RRT arrival.…”

Section: Vital Signs Upon Rrt Arrivalmentioning

confidence: 99%

See 1 more Smart Citation

Afferent limb failure revisited – A retrospective, international, multicentre, cohort study of delayed rapid response team calls

et al. 2020

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Section: Vital Signs Upon Rrt Arrivalsupporting

confidence: 89%

Section: Vital Signs Upon Rrt Arrivalmentioning

confidence: 99%

Afferent limb failure revisited – A retrospective, international, multicentre, cohort study of delayed rapid response team calls

et al. 2020

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“…Some rapid response team (RRT) patients may be incorrectly triaged to remain on wards; this leads to repeat RRT reviews and possible delays in ICU admittance/ higher morbidity [9, 10]. There are very limited data on the physiological state of the patients that s RRTs actually evaluate on general wards, although vital signs recorded during the reviews could provide important information for system-development, trans-institutional comparisons and data validation.…”

Section: Introductionmentioning

confidence: 99%

National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

Tirkkonen

Karlsson

Skrifvars

2019

Scand J Trauma Resusc Emerg Med

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BackgroundThe national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT.MethodsWe conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT.ResultsThe final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively.ConclusionsWe found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

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“…competence of the RRT staff, critical care capacity and local routines and traditions when assessing need for critical care. 26 Taking into consideration that many previous studies are retrospective, our results from a prospective study might suggest the need for a complementary, supportive triage tool in order to enable accurate decisions on the need for ICU admission during RRT assessments.…”

Section: Discussionmentioning

confidence: 96%

“…The ability of NEWS and NEWS 2 in this study to predict ICU admissions amongst patients assessed by the RRT was rather weak, both in absolute terms and compared to previous studies. Deranged vital signs recorded by the RRT during a review has previously been identified as an independent risk factor for 30-day mortality despite interventions of the RRT, 26 hence a timely and adequate triage of patients in need of intensive care is of vital importance. However, decisions on ICU admittance are under the influence of many factors, e.g.…”

Section: Discussionmentioning

confidence: 99%

The predictive power of the National Early Warning Score (NEWS) 2, as compared to NEWS, among patients assessed by a Rapid response team: A prospective multi-centre trial

et al. 2022

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Aim Early identification of patients at risk of serious adverse events (SAEs) is of vital importance, yet it remains a challenging task. We investigated the predictive power of National Early Warning Score (NEWS) 2, as compared to NEWS, among patients assessed by a Rapid response team (RRT). Methods Prospective, observational cohort study on 898 consecutive patients assessed by the RRTs in 26 Swedish hospitals. For each patient, NEWS and NEWS 2 scores were uniformly calculated by the study team. The associations of NEWS and NEWS 2 scores with unanticipated admissions to Intensive care unit (ICU), mortality and in-hospital cardiac arrests (IHCA) within 24 h, and the composite of these three events were investigated using logistic regression. The predictive power of NEWS and NEWS 2 was assessed using the area under the receiver operating characteristic (AUROC) curves. Results The prognostic accuracy of NEWS/NEWS 2 in predicting mortality was acceptable (AUROC 0.69/0.67). In discriminating the composite outcome and unanticipated ICU admission, both NEWS and NEWS 2 were relatively weak (AUROC 0.62/0.62 and AUROC 0.59/0.60 respectively); for IHCA the performance was poor. There were no differences between NEWS and NEWS 2 as to the predictive power. Conclusion The prognostic accuracy of NEWS 2 to predict mortality within 24 h was acceptable. However, the prognostic accuracy of NEWS 2 to predict IHCA was poor. NEWS and NEWS 2 performed similar in predicting the risk of SAEs but their performances were not sufficient for use as a risk stratification tool in patients assessed by a RRT.

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Rapid response team patients triaged to remain on ward despite deranged vital signs: missed opportunities?

Abstract: Patients triaged to stay on ward despite deranged vital signs are high-risk patients who could benefit from routine follow-up by RRT nurses before they deteriorate beyond salvation.

Cited by 8 publications

References 23 publications

Afferent limb failure revisited – A retrospective, international, multicentre, cohort study of delayed rapid response team calls

Afferent limb failure revisited – A retrospective, international, multicentre, cohort study of delayed rapid response team calls

National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

The predictive power of the National Early Warning Score (NEWS) 2, as compared to NEWS, among patients assessed by a Rapid response team: A prospective multi-centre trial

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