The use of altered rapid response calling criteria in a tertiary referral facility

Abstract

Purpose:The purpose of this study was to examine the current utilisation of altered rapid response call criteria (ARRCC) at a tertiary hospital. Methods :A retrospective review of all acute care admissions across 17 months was undertaken using the hospital administration system and electronic medical record to identify patients with ARRCC. In patients with altered criteria, the type of alteration, frequency of rapid response call, cardiac arrest, intensive care admission and death in hospital were identified.Comparisons were made using standard statistical methods.Results : Total hospital admissions numbered 45,912, with ARRCC used in 768 (1.7%) of these. Patients with an ARRCC during hospital admission were older (68.5 [55.5, 79.0] vs 59.0 [43.0, 72.0] years, p<0.001) and had a significantly longer length of hospital stay (6.9 [3.0,16.3] vs 2 [1,5] days, p<0.001).Compared with the total group of patient admissions, patients with ARRCC more frequently triggered a rapid response team (9.0% vs 14.2%, X 2 (1, n=46680) = 23.87, p<0.001), more frequently suffered a cardiac arrest (0.2 vs 0.9%, X 2 (1, n=46678) = 20.34, p<0.001), more frequently died in hospital (p<0.001), and less frequently were discharged home (X 2 (1, n=46680) = 43.91, p<0.001). Conclusion :Patients with an ARRCC stayed longer in hospital and were at increased risk of cardiac arrest and death during hospitalisation. Further exploration of the role of ARRCC in facilitating individualised care to meet the needs and treatment goals of each patient in the acute hospital setting is required.

Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

“…In a more recent study (also conducted in Australia) similar findings were reported, whereby patients with adjusted criteria more frequently triggered an efferent limb activation, more frequently had a cardiac arrest and more frequently died in hospital compared to patients with standard (i.e. unmodified) criteria (Crouch et al, 2020). These findings highlight the potential vulnerability of the sub‐group of patients likely to have response criteria modified, the potential safety implications of reducing the level of response and the complexity of the clinical decisions that underpin these adjustments.…”

Long term survival following a medical emergency team call at an Australian regional hospital

“… 29 A retrospective, single-centre study identified that nearly one-quarter of alterations to the MET criteria were made by junior doctors, and that altered MET trigger criteria were significantly associated with ICU admission, in-hospital cardiac arrest and in-hospital death. 30 Our findings reiterate that great care must be taken when altering MET criteria.…”

Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study

“…5 In prospective data, the prevalence of discharge home after receiving RRS activation was approximately 50%, consistent with our results, while the prevalence of discharge home after hospitalization was 86.8%. 5 , 12 These results indicate that adverse events were associated with less frequency of discharge home. There might be several reasons for the low frequency of discharge home after hospitalization.…”

“…Few published reports describe the outcomes of patients with adverse events who required RRS activation and were discharged home 5 . In prospective data, the prevalence of discharge home after receiving RRS activation was approximately 50%, consistent with our results, while the prevalence of discharge home after hospitalization was 86.8% 5,12 . These results indicate that adverse events were associated with less frequency of discharge home.…”