title: The duration of hospitalization before review by the rapid response team: A retrospective cohort study.
abstract: OBJECTIVE
  The purpose of this study is to compare cases of rapid response team (RRT) review for early deterioration (<48 hours after admission), intermediate deterioration (48 to <168 hours after admission), late deterioration (≥168 hours after admission), and cardiac arrest and to determine the association between duration of hospitalization before RRT review and mortality.
  
  
  METHODS
  This is a retrospective cohort study of RRT cases from a single hospital over 5 years (2009-2013) using administrative data and data for the first RRT attendance of each hospital episode.
  
  
  RESULTS
  Of 2843 RRT cases, 971 (34.2%) were early deterioration, 917 (32.3%) intermediate, 775 (27.3%) late, and 180 (6.3%) cardiac arrest. Compared with early deterioration patients, late deterioration patients were older (median, 71 vs 69 years; P = .005), had a higher Charlson comorbidity index (median, 2 vs 1; P < .001), more often had RRT review for respiratory distress (32.5% vs 23.5%; P < .001), more often received RRT-initiated not for resuscitation orders (8.4% vs 3.9%; P < .001), less often were discharged directly home (27.9% vs 58.4%; P < .001), and more often died in hospital (30.6% vs 12.8%; P < .001). Compared with early deterioration and adjusted for confounders, the odds ratio of death in hospital for late deterioration was 2.36 (1.81-3.08; P < .001).
  
  
  CONCLUSIONS
  Late deterioration is frequently encountered by the RRT and, compared with early deterioration, is associated with greater clinical complexity and a worse hospital outcome.
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia. Electronic address: roger.smith@svha.org.au.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Smith
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia. Electronic address: john.santamaria@svha.org.au.
authors.forename: John D
authors.initials: JD
authors.lastname: Santamaria
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia. Electronic address: espedito.faraone@svha.org.au.
authors.forename: Espedito E
authors.initials: EE
authors.lastname: Faraone
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia. Electronic address: jennifer.holmes@svha.org.au.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Holmes
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia. Electronic address: david.reid@svha.org.au.
authors.forename: David A
authors.initials: DA
authors.lastname: Reid
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Australia. Electronic address: antony.tobin@svha.org.au.
authors.forename: Antony E
authors.initials: AE
authors.lastname: Tobin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013997:Time Factors
keywords: Clinical deterioration; Hospital mortality; Medical emergency team; Rapid response team