title: Hospital rapid response team and patients with life-limiting illness: a multicentre retrospective cohort study.
abstract: BACKGROUND
  Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered.
  
  
  OBJECTIVE
  We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness.
  
  
  METHODS
  A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network.
  
  
  RESULTS
  We identified 351 patients - including 139 with a life-limiting illness - receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness.
  
  
  CONCLUSIONS
  Patients with a life-limiting illness had worse outcomes post-rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.
authors: Department of Palliative Medicine, Cabrini Health, Melbourne, VIC, Australia merlina.sulistio@gmail.com.
authors: Merlina
authors: M
authors: Sulistio
authors: McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia.
authors: Michael
authors: M
authors: Franco
authors: McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia.
authors: Amanda
authors: A
authors: Vo
authors: McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia Eastern Palliative Care, Melbourne, VIC, Australia.
authors: Peter
authors: P
authors: Poon
authors: McCulloch House Supportive and Palliative Care Unit, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia Palliative Care Unit, Eastern Health, Melbourne, VIC, Australia.
authors: Leeroy
authors: L
authors: William
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D057209:Hospital Rapid Response Team; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D018802:Patient-Centered Care / Q000592:standards; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards
keywords: Rapid response team; advance care planning; cardiac arrest; end-of-life care; goals of care; resuscitation orders