title: Epidemiology of early Rapid Response Team activation after Emergency Department admission.
abstract: BACKGROUND
  Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration.
  
  
  METHODS
  Retrospective case-controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls).
  
  
  RESULTS
  Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84 beats/min; p=0.008); after 3h in the ED (91 vs. 80 beats/min; p=0.0007); and at ED discharge (91 vs. 81 beats/min; p=0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2 breaths/min; p=0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02-1.12] for each 1 breath/min increase in RR; and 1.02 [95% CI 1.002-1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86-11.65]; p=0.0003) compared with controls.
  
  
  CONCLUSIONS
  Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia. Electronic address: juancarlosmora@doctors.net.uk.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Mora
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Antoine
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Administrative Informatics, Austin Hospital, Melbourne, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Robbins
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Bebee
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: Yu-Feng Frank
authors.initials: YF
authors.lastname: Hsiao
authors.affiliation: Eastern Health - Deakin University Nursing and Midwifery Research Centre/Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology
keywords: Emergency medicine; Hospital Rapid Response Team; Intensive care units; Mortality; Triage