title: The rapid response team in outpatient settings identifies patients who need immediate intensive care unit admission: A call for policy maker.
abstract: BACKGROUND
  Caregivers in the ambulatory care setting with differing clinical background could encounter a patient at high risk of deterioration. In the absence of a dedicated acute care team, the response to an unanticipated medical emergencies in these settings is likely to have a poor outcome.
  
  
  OBJECTIVE
  To describe our experience in implementing an intensivist-led rapid response team (RRT) in the outpatient settings that identified patients who needed immediate Intensive Care Unit (ICU) admission. The effect on in hospital arrests, mortality, and ICU outcome is not the scope of this study.
  
  
  METHODS
  This retrospective descriptive study was performed from January 1, 2009 to December 31, 2011 in a tertiary hospital. Data from hospital records were used (none from patients' records). Consent was not needed.
  
  
  METHODS
  Direct ICU admissions from the outpatient areas.
  
  
  RESULTS
  There were 90 patients cared for by RRT in the outpatient's settings, 76 adult, and 14 pediatric patients. A total of12 adult patients were transferred directly to ICU. Among the patient who were transferred to the emergency department, additional four patients required to be transferred to ICU (total 16 patients [17.7%], 15 adult, and one pediatric patient). Follow-up at 24 h in the ICU showed death of one adult oncology patient (6.25%), and discharge of two patients (12.5%). Nine patients (81%) were still sick to require longer ICU stay.
  
  
  CONCLUSIONS
  Intensivist-led RRT in outpatient settings identifies patients who are critically ill and in need of immediate ICU admission. Thus, an intensivist-led RRT policy in the outpatient settings needs to be implemented hospital wide.
authors.affiliation: Department of Adult Critical Care Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mariam A
authors.initials: MA
authors.lastname: Alansari
authors.affiliation: Neuro-Critical Care, London Health Sciences Centre, University of Western London, Ontario, Canada.
authors.forename: Eyad A
authors.initials: EA
authors.lastname: Althenayan
authors.affiliation: Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Hijazi
authors.affiliation: Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Maghrabi
keywords: Intensive care admission; outpatient; safety rapid response system