Elsevier

Resuscitation

Volume 107, October 2016, Pages 7-12
Resuscitation

Rapid response systems
Clinical outcomes of patients seen by Rapid Response Teams: A template for benchmarking international teams

https://doi.org/10.1016/j.resuscitation.2016.07.001Get rights and content

Abstract

Aim

The study was developed to characterize short-term outcomes of deteriorating ward patients triggering a Rapid Response Team (RRT), and describe variability between hospitals or groups thereof.

Methods

We performed an international prospective study of Rapid Response Team (RRT) activity over a 7-day period in February 2014. Investigators at 51 acute hospitals across Australia, Denmark, the Netherlands, USA and United Kingdom collected data on all patients triggering RRT review concerning the nature, trigger and immediate outcome of RRT review. Further follow-up at 24 h following RRT review focused on patient orientated outcomes including need for admission to critical care, change in limitations of therapy and all cause mortality.

Results

We studied 1188 RRT activations. Derangement of vital signs as measured by the National Early Warning Score (NEWS) was more common in non-UK hospitals (p = 0.03). Twenty four hour mortality after RRT review was 10.1% (120/1188). Urgent transfer to ICU or the operating theatre occurred in 24% (284/1188) and 3% (40/1188) of events, respectively. Patients in the UK were less likely to be admitted to ICU (31% vs. 22%; p = 0.017) and their median (IQR) time to ICU admission was longer [4.4 (2.0–11.8) vs. 1.5 (0.8–4.4) h; p < 0.001]. RRT involvement lead to new limitations in care in 28% of the patients not transferring to the ICU; in the UK such limitations were instituted in 21% of patients while this occurred in 40% of non-UK patients (p < 0.001).

Conclusion

Among patients triggering RRT review, 1 in 10 died within 24 h; 1 in 4 required ICU admission, and 1 in 4 had new limitations in therapy implemented. We provide a template for an international comparison of outcomes at RRT level.

Introduction

Patients admitted to hospital wards have increasingly complex conditions and multiple co-morbidities.1, 2 Rapid Response Teams (RRTs) and similar services have been introduced to identify, review and treat at-risk and deteriorating ward patients in an attempt to reduce serious adverse events, cardiac arrests, and unplanned admissions to the intensive care unit (ICU).3, 4 The characteristics of patients subject to RRT review5 and typical triggers for RRT calls6 are known. At the same time in-hospital mortality rate of patients seen by RRTs is in the order of 20%.7, 8, 9, 10

Most of the literature related to RRTs evaluates the effects of introducing a RRT on outcomes of all hospitalized patients. Less information exists about the immediate outcomes of individual patients after RRT review or how patient outcomes after RRT review may vary between countries. This information is important as results of RRT implementations are being reported from an increasing number of countries with divergent health care systems. Improvements such as those recently reported from a French group of hospitals11 might be due to changes in hospital culture or due to changes in outcomes of the group of sick patients seen by RRTs.

The purpose of this study was to examine the short-term (24 h) outcome of patients triggering RRT review and the variations in such outcomes between hospitals from different countries.

Section snippets

Definitions

For the purpose of this manuscript, the term Rapid Response Team (RRT) is used to describe Rapid Response Teams, Medical Emergency Teams or Critical Care Outreach Teams, and RRT denotes individuals or groups of health care professionals responding to deteriorating hospitalized patients in locations other than Intensive Care.

Ethics approval

The human ethics committee at each location approved participation, and data handling conformed to local practices. For the UK, we obtained formal approval from the Human

Baseline characteristics of study centres demographics

Fifty-one sites from Australia (3), Denmark (4) the Netherlands (1), the United Kingdom (40) and the United States (3) took part in the study. Participating hospitals had a median of 500 beds (IQR 400–762); the median number of new patients seen by teams during the study week was 25 (IQR 15–35). A comparison of the 40 UK and 11 non-UK sites based on the characteristics of their RRT in terms of model and leadership is shown in Table 1. The majority of UK RRTs were nurse led, compared to non-UK

Discussion

We studied the features, management, and immediate outcomes of 1188 general ward patients receiving Rapid Response Team review in 51 centres across five countries, and compared short-term patient outcomes in UK vs. non-UK hospitals. Overall, we found that approximately 1 patient in 10 died within 24 h; one quarter of calls resulted in ICU transfer, and one quarter resulted in changes to treatment limitations. Focusing on UK data we found, a higher frequency of ward deaths with “full care”

Conclusion

The present paper offers clinicians a standardized benchmarking dataset for short-term outcomes of RRT interventions. Within 24 h of an RRT event, 1 patient in 10 will be dead, 1 in 4 will be transferred to ICU, and 1 in 4 will have limitation of care orders. These results might differ between hospitals and countries. The factors contributing to these outcomes and differences in process of care require further exploration as does investigation of longer-term outcomes.

Conflict of Interest Statement

All contributing authors listed have no competing interests to declare.

Acknowledgements

Special thanks to the International Society for Rapid Response Systems (iSRRS) and the UK National Outreach Forum (NOrF) for their support and assistance in recruiting site investigators.

Collaborators consented to the statement that ‘Health Research Ethics Committee (HREC) approval has been obtained or need for HREC approval been waived locally.’ All ethics committees approached gave their approval.

The METHOD site investigators: [alphabetically by institution, all in the United Kingdom unless

References (23)

  • M. DeVita

    Medical emergency teams: deciphering clues to crises in hospitals

    Crit Care

    (2005)
  • Cited by (0)

    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.07.001.

    1

    On behalf of the Medical Emergency Teams: Hospital Outcomes in a Day (METHOD) study investigators. The Medical Emergency Team Hospital Outcomes in a Day (METHOD) investigators are listed in the Acknowledgements section.

    View full text