title: Enhanced end-of-life care associated with deploying a rapid response team: a pilot study.
abstract: OBJECTIVE
  Institution of a rapid response team (RRT) improves patients' quality of death (QOD).
  
  
  METHODS
  A 425-bed community teaching hospital.
  
  
  METHODS
  : All medical-surgical patients whose end-of-life care was initiated on the hospital wards during the 8 months before (pre-RRT) and after (post-RRT) actuation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Medical records of all patients were reviewed using a uniform data abstraction tool. Demographic information, diagnoses, physiologic and laboratory data, and outcomes were recorded.
  
  
  RESULTS
  A total of 197 patients died in both the pre-RRT and post-RRT periods. There were no differences in age, sex, advance directives, ethnicity, or religion between groups. Restorative outcomes, including in-hospital mortality (27 vs. 30/1000 admissions), unexpected transfers to intensive care (17 vs. 19/1000 admissions) and cardiac arrests (3 vs. 2.5/1000 admissions) were similar during the 2 periods. Outcomes, including formal comfort care only orders (68 vs. 46%), administration of opioids (68 vs. 43%), pain scores (3.0 +/- 3.5 vs. 3.7 +/- 3.2), patient distress (26 vs. 62%), and chaplain visits (72 vs. 60%), were significantly better in the post-RRT period compared to the pre-RRT period (all P < 0.05). During the post-RRT period, 61 patients died with RRT care and 136 died without RRT care. End-of-life care outcomes were similar for these groups except more RRT patients had chaplain visits proximate to their deaths (80% vs. 68%; P = 0.0001).
  
  
  CONCLUSIONS
  Institution of an RRT in our hospital had negligible impact on outcomes of patients whose goal was restorative care. Deployment of the RRT was associated with generally improved end-of-life pain management and psychosocial care.
authors.affiliation: Bridgeport Hospital and Yale University School of Medicine, Bridgeport, Connecticut 06610, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vazquez
authors.forename: Cristina
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Artur
authors.initials: A
authors.lastname: Grigoriyan
authors.forename: Tatsiana
authors.initials: T
authors.lastname: Palvinskaya
authors.forename: Yaw
authors.initials: Y
authors.lastname: Amoateng-Adjepong
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Manthous
mesh_terms: D000368:Aged; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013727:Terminal Care / Q000458:organization & administration*