title: Medical Rapid Response in Psychiatry: Reasons for Activation and Immediate Outcome.
abstract: Rapid response teams are used to improve the recognition of acute deteriorations in medical and surgical settings. They are activated by abnormal physiological parameters, symptoms or clinical concern, and are believed to decrease hospital mortality rates. We evaluated the reasons for activation and the outcome of rapid response interventions in a 222-bed psychiatric hospital in New York City using data obtained at the time of all activations from January through November, 2012. The primary outcome was the admission rate to a medical or surgical unit for each of the main reasons for activation. The 169 activations were initiated by nursing staff (78.7 %) and psychiatrists (13 %) for acute changes in condition (64.5 %), abnormal physiological parameters (27.2 %) and non-specified concern (8.3 %). The most common reasons for activation were chest pain (14.2 %), fluctuating level of consciousness (9.5 %), hypertension (9.5 %), syncope or fall (8.9 %), hypotension (8.3 %), dyspnea (7.7 %) and seizures (5.9 %). The rapid response team transferred 127 (75.2 %) patients to the Emergency Department and 46 (27.2 %) were admitted to a medical or surgical unit. The admission rates were statistically similar for acute changes in condition, abnormal physiological parameters, and clinicians' concern. In conclusion, a majority of rapid response activations in a self-standing psychiatric hospital were initiated by nursing staff for changes in condition, rather than for policy-specified abnormal physiological parameters. The findings suggest that a rapid response system may empower psychiatric nurses to use their clinical skills to identify patients requiring urgent transfer to a general hospital.
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA. pmanu@nshs.edu.|Hofstra North Shore - Long Island Jewish School of Medicine at Hofstra University, Hempstead, NY, USA. pmanu@nshs.edu.|Albert Einstein College of Medicine, Bronx, NY, USA. pmanu@nshs.edu.
authors: Peter
authors: P
authors: Manu
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.|Adelphi University College of Nursing and Public Health, Garden City, USA.
authors: Kristy
authors: K
authors: Loewenstein
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
authors: Yankel J
authors: YJ
authors: Girshman
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
authors: Padam
authors: P
authors: Bhatia
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
authors: Maira
authors: M
authors: Barnes
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
authors: Joseph
authors: J
authors: Whelan
authors: Long Island Jewish Medical Center, New Hyde Park, NY, USA.
authors: Victoria A
authors: VA
authors: Solderitch
authors: Transilvania University, Brasov, Romania.
authors: Liliana
authors: L
authors: Rogozea
authors: Patient Care Services, Zucker Hillside Hospital, North Shore - LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
authors: Marybeth
authors: M
authors: McManus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006282:Health Personnel; D057209:Hospital Rapid Response Team; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009519:New York City; D010043:Outcome and Process Assessment, Health Care; D011570:Psychiatry; D021641:Recognition, Psychology; D055815:Young Adult
keywords: Acute medical deteriorations; Psychiatric hospitals; Rapid response