title: Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution.
abstract: OBJECTIVE
  To identify whether delays in rapid response team activation contributed to worse patient outcomes (mortality and morbidity).
  
  
  METHODS
  Retrospective observational cohort study including all rapid response team activations in 2012.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  All those 18 years old or older who had a rapid response team call activated. Vital sign data were abstracted from individual patient electronic medical records for the 24 hours before the rapid response team activation took place. Patients were considered to have a delayed rapid response team activation if more than 1 hour passed between the first appearance in the record of an abnormal vital sign meeting rapid response team criteria and the activation of an rapid response team.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 1,725 patients were included in the analysis. Data were compared between those who had a delayed rapid response team activation and those who did not. Fifty seven percent patients met the definition of delayed rapid response team activation. Patients in high-frequency physiologic monitored environments were more likely to experience delay than their floor counterparts. In the no-delay group, the most common reasons for rapid response team activation were tachycardia/bradycardia at 29% (217/748), respiratory distress/low SpO2 at 28% (213/748), and altered level of consciousness at 23% (170/748) compared with respiratory distress/low SpO2 at 43% (423/977), tachycardia/bradycardia at 33% (327/977), and hypotension at 27% (261/977) in the delayed group. The group with no delay had a higher proportion of rapid response team calls between 8:00 and 16:00, whereas those with delay had a higher proportion of calls between midnight and 08:00. The delayed group had higher hospital mortality (15% vs 8%; adjusted odds ratio, 1.6; p = 0.005); 30-day mortality (20% vs 13%; adjusted odds ratio, 1.4; p = 0.02); and hospital length of stay (7 vs 6 d; relative prolongation, 1.10; p = 0.02) compared with the no-delay group.
  
  
  CONCLUSIONS
  Delays in rapid response team activation occur frequently and are independently associated with worse patient mortality and morbidity outcomes.
authors.affiliation: 1Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN.2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester MN.3Division of Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
authors.forename: Amelia
authors.initials: A
authors.lastname: Barwise
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jensen
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pickering
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors