title: Rapid response teams, do not resuscitate orders, and potential opportunities to improve end-of-life care: a multicentre retrospective study.
abstract: OBJECTIVE
  Rapid response teams (RRTs) were created to stabilize acutely ill patients on the ward, but recent studies suggest that RRTs may improve end-of-life care (EOLC). To learn more about the role of the RRT in EOLC at our institutions, we conducted a retrospective review.
  
  
  METHODS
  Retrospective review of 300 RRT consultations at 3 academic hospitals in Toronto, Canada.
  
  
  RESULTS
  The typical consultation was for an elderly patient with chronic illness. More than 90% had a "full resuscitation" order at the time of consultation. One third were admitted to the intensive care unit within 48 hours of the RRT consultation, and 24.7% ultimately died. Twenty-seven (9.3%) had a patient/family conference on the ward within 48h of the RRT consultation, 24 (8.3%) of whom changed their resuscitation order as a result. Among those who changed their resuscitation order, fewer than 20% were referred to the palliative care or spiritual care service, or prescribed comfort medications as needed (pro re nata), within 48 h of the RRT consultation; 2 patients died without receiving any common EOLC orders, and 15 (63%) died before discharge.
  
  
  CONCLUSIONS
  RRT consultation is an important milestone for many patients approaching EOL. RRTs frequently participate in EOL discussions and decision-making, but they may miss opportunities to facilitate EOLC.
authors: Critical Care and Palliative Care, University Health Network, 9N-926, Toronto, Canada, M5G 2C4. james.downar@utoronto.ca
authors: James
authors: J
authors: Downar
authors: Danielle
authors: D
authors: Rodin
authors: Reeta
authors: R
authors: Barua
authors: Brandon
authors: B
authors: Lejnieks
authors: Rakesh
authors: R
authors: Gudimella
authors: Victoria
authors: V
authors: McCredie
authors: Chris
authors: C
authors: Hayes
authors: Andrew
authors: A
authors: Steel
mesh_terms: D000368:Aged; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D009864:Ontario; D010166:Palliative Care; D058996:Quality Improvement; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration*
keywords: Critical care; Hospital rapid response team; Palliative care; Resuscitation orders; Terminal care; Withholding treatment