title: Changes in end of life care 5 years after the introduction of a rapid response team: a multicentre retrospective study.
abstract: BACKGROUND
  Rapid response teams (RRTs) are intended to stabilize deteriorating patients on the ward, but recent studies suggest that RRTs may also improve end-of-life care (EOLC). We sought to study the effect of introducing an RRT on EOLC at our institutions, and compare the EOLC care received by patients who were consulted by the RRT with that of patients who were not consulted by the RRT.
  
  
  METHODS
  Retrospective review of 450 consecutive deaths at 3 institutions. We compared demographic factors and EOLC received before (2005) and 5 years after (2010) the introduction of an RRT. We also compared these same factors for patients who died in 2010 with and without RRT consultation.
  
  
  RESULTS
  There were no differences in the proportion of patients who had Patient/Family Conferences or orders to limit life support on the ward between 2005 and 2010. Although the RRT was consulted for 30% of patients eligible to be seen by the RRT, the RRT was involved in only 11.1% of Patient/Family Conferences that took place on the ward. The prevalence of palliative care consultation and orders for opioids as needed was higher in 2010 than 2005, but those seen by the RRT were less likely to receive a palliative care consultation (30.2% vs. 55.9%), spiritual care consultation (25.4% vs. 41.3%) or an order for sedatives as needed (44.4% vs. 65.0%) than those who were not seen by the RRT. There was no change in the proportion of patients admitted to the ICU in 2010 compared with 2005, and multivariable logistic regression showed that the year of death did not influence the likelihood of ICU admission based on any comorbid or demographic factors.
  
  
  CONCLUSIONS
  The introduction of an RRT was not associated with significant improvements in EOLC at our institutions. However, almost 1/3 of dying patients were consulted by the RRT, suggesting that the RRT could play a role in facilitating improved EOLC for some inpatients.
authors.affiliation: Critical Care and Palliative Care, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: James.downar@utoronto.ca.
authors.forename: James
authors.initials: J
authors.lastname: Downar
authors.forename: Reeta
authors.initials: R
authors.lastname: Barua
authors.forename: Danielle
authors.initials: D
authors.lastname: Rodin
authors.forename: Brandon
authors.initials: B
authors.lastname: Lejnieks
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gudimella
authors.forename: Victoria
authors.initials: V
authors.lastname: McCredie
authors.forename: Chris
authors.initials: C
authors.lastname: Hayes
authors.forename: Andrew
authors.initials: A
authors.lastname: Steel
mesh_terms: D000368:Aged; D003142:Communication; D005260:Female; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D013997:Time Factors
keywords: Critical care; DNR; EOLC; Hospital rapid response team; PC; PRN; Palliative care; RRT; Resuscitation orders; SC; Terminal care; WDLS; WHLS; Withholding treatment; end of life care; palliative care; pro re nata (as needed); rapid response team; spiritual care; withdraw life support; withhold life support; “do not resuscitate”