Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study.
BACKGROUND
The characteristics of mature contemporary rapid response systems are unclear.


OBJECTIVE
To determine the patient characteristics, processes and outcomes, both in-hospital and post-discharge, of a well-established rapid response system in a tertiary adult hospital.


METHODS
This is a prospective study of consecutive rapid response team (RRT) activations between 1 July and 25 November 2015. Variables included patient characteristics, timing, location and triggers of RRT activations, interventions undertaken, mortality and readmission status at 28 days post-discharge.


RESULTS
A total of 1151 RRT activations was analysed (69.1 per 1000 admissions), involving 800 patients, of whom 81.5% were emergency admissions. A total of 351 (30.5%) activations comprised repeat activations for the same patient. Most activations (723; 62.8%) occurred out of hours, and 495 (43%) occurred within 48 h of admission. Hypotension, decreased level of consciousness and oxygen desaturation were the most common triggers. Advanced life support was undertaken in less than 7%; 198 (17.2%) responses led to transfer to higher-level care units. Acute resuscitation plans were noted for only 29.1% of RRT activations, with 80.3% stipulating supportive care only. A total of 103 (12.6%) patients died in hospital, equalling 14 deaths per 100 RRT activations. At 28 days, 150 (18.8%) patients had died, significantly more among those with multiple versus single RRT activations (24.9 vs 16.6%; odds ratio 1.66, 95% confidence interval 1.31-2.44; P = 0.013).


CONCLUSIONS
Relatively few RRT activations are associated with acute resuscitation plans, and most interventions during RRT responses are low level. The high rate of post-RRT deaths and transfers to higher-level care units calls for the prospective identification of such patients in targeting appropriate care.
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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K
White
Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Scott
Queensland Facility for Advanced Bioinformatics, Brisbane, Queensland, Australia.
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A
Bernard
Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
K
K
McCulloch
Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
A
A
Vaux
Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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C
Joyce
Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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CM
Sullivan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D019985:Benchmarking; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult
interventions; outcomes; patient characteristics; prospective study; rapid response teams; tertiary hospital