title: Clinical outcomes of patients seen by Rapid Response Teams: A template for benchmarking international teams.
abstract: The study was developed to characterize short-term outcomes of deteriorating ward patients triggering a Rapid Response Team (RRT), and describe variability between hospitals or groups thereof.
  
  
  
  We performed an international prospective study of Rapid Response Team (RRT) activity over a 7-day period in February 2014. Investigators at 51 acute hospitals across Australia, Denmark, the Netherlands, USA and United Kingdom collected data on all patients triggering RRT review concerning the nature, trigger and immediate outcome of RRT review. Further follow-up at 24h following RRT review focused on patient orientated outcomes including need for admission to critical care, change in limitations of therapy and all cause mortality.
  
  
  
  We studied 1188 RRT activations. Derangement of vital signs as measured by the National Early Warning Score (NEWS) was more common in non-UK hospitals (p=0.03). Twenty four hour mortality after RRT review was 10.1% (120/1188). Urgent transfer to ICU or the operating theatre occurred in 24% (284/1188) and 3% (40/1188) of events, respectively. Patients in the UK were less likely to be admitted to ICU (31% vs. 22%; p=0.017) and their median (IQR) time to ICU admission was longer [4.4 (2.0-11.8) vs. 1.5 (0.8-4.4)h; p<0.001]. RRT involvement lead to new limitations in care in 28% of the patients not transferring to the ICU; in the UK such limitations were instituted in 21% of patients while this occurred in 40% of non-UK patients (p<0.001).
  
  
  
  Among patients triggering RRT review, 1 in 10 died within 24h; 1 in 4 required ICU admission, and 1 in 4 had new limitations in therapy implemented. We provide a template for an international comparison of outcomes at RRT level.
authors.affiliation: Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, VIC, Australia. Electronic address: jonbannardsmith@doctors.org.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bannard-Smith
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr. H3580, Stanford, CA 94305, USA. Electronic address: geoffl@stanford.edu.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Lighthall
authors.affiliation: Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, UK. Electronic address: csubbe@hotmail.com.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Subbe
authors.affiliation: North of England Critical Care Network, North Tyneside General Hospital, Rake Lane, North Shields, Northumberland, UK. Electronic address: lesley.durham@northumbria-healthcare.nhs.uk.
authors.forename: Lesley
authors.initials: L
authors.lastname: Durham
authors.affiliation: Critical Care & Critical Care Outreach, University College London Hospitals, UK. Electronic address: john.welch@uclpartners.com.
authors.forename: John
authors.initials: J
authors.lastname: Welch
authors.affiliation: Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, VIC, Australia. Electronic address: rinaldo.bellomo@austin.org.au.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, VIC, Australia. Electronic address: daryl.jones@austin.org.uk.
authors.forename: Daryl A
authors.initials: DA
authors.lastname: Jones
mesh_terms: D000368:Aged; D001315:Australia; D019985:Benchmarking / Q000379:methods*; D003422:Critical Care / Q000379:methods / Q000592:standards; D003718:Denmark; D005260:Female; D057209:Hospital Rapid Response Team / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012107:Research Design; D016019:Survival Analysis; D006113:United Kingdom; D014481:United States
keywords: Acute illness; Critical care outreach; Early warning score; Medical emergency teams; Rapid Response Teams