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A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.

ABSTRACT: Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs.To determine if real-time alerts sent to the rapid response team (RRT) improved patient care.Randomized, controlled trial.Eight medicine units (Barnes-Jewish Hospital).Five hundred seventy-one patients.Real-time alerts generated by a validated deterioration algorithm were sent real-time to the RRT (intervention) or hidden (control).Intensive care unit (ICU) transfer, hospital mortality, hospital duration.ICU transfer (17.8% vs 18.2%; odds ratio: 0.972; 95% confidence interval [CI]: 0.635-1.490) and hospital mortality (7.3% vs 7.7%; odds ratio: 0.947; 95% CI: 0.509-1.764) were similar for the intervention and control groups. The number of patients requiring transfer to a nursing home or long-term acute care hospital was similar for patients in the intervention and control groups (26.9% vs 26.3%; odds ratio: 1.032; 95% CI: 0.712-1.495). Hospital duration (8.4?±?9.5 days vs 9.4?±?11.1 days; P = 0.038) was statistically shorter for the intervention group. The number of RRT calls initiated by the primary care team was similar for the intervention and control groups (19.9% vs 16.5%; odds ratio: 1.260; 95% CI: 0.823-1.931).Real-time alerts sent to the RRT did not reduce ICU transfers, hospital mortality, or the need for subsequent long term care. However, hospital length of stay was modestly reduced.

SUBMITTER: Kollef MH

PROVIDER: S-EPMC4354800 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.

Kollef Marin H MH Chen Yixin Y Heard Kevin K LaRossa Gina N GN Lu Chenyang C Martin Nathan R NR Martin Nelda N Micek Scott T ST Bailey Thomas T

Journal of hospital medicine 20140407 7

<h4>Background</h4>Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs.<h4>Objective</h4>To determine if real-time alerts sent to the rapid response team (RRT) improved patient care.<h4>Design</h4>Randomized, controlled trial.<h4>Setting</h4>Eight medicine units (Barnes-Jewish Hospital).<h4>Patients</h4>Five hundred seventy-one patients.<h4>Intervention</h4>Real-time alerts generated by a validated deterioration algorithm ...[more]

PMID: 24706596

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Project description:Clinical deterioration of hospitalized patients is common and can lead to critical illness and death. Rapid response teams (RRTs) assess and treat high-risk patients with signs of clinical deterioration to prevent further worsening and subsequent adverse outcomes. Whether activation of the RRT early in the course of clinical deterioration impacts outcomes, however, remains unclear. We sought to characterize the relationship between increasing time to RRT activation after physiologic deterioration and short-term patient outcomes.DesignRetrospective multicenter cohort study.SettingThree academic hospitals in Pennsylvania.PatientsWe included the RRT activation of a hospitalization for non-ICU inpatients greater than or equal to 18 years old.InterventionsNone.Measurements and main resultsThe primary exposure was time to RRT activation after physiologic deterioration. We selected four Cardiac Arrest Risk Triage (CART) score thresholds a priori from which to measure time to RRT activation (CART score ≥ 12, ≥ 16, ≥ 20, and ≥ 24). The primary outcome was 7-day mortality-death or discharge to hospice care within 7 days of RRT activation. For each CART threshold, we modeled the association of time to RRT activation duration with 7-day mortality using multivariable fractional polynomial regression. Increased time from clinical decompensation to RRT activation was associated with higher risk of 7-day mortality. This relationship was nonlinear, with odds of mortality increasing rapidly as time to RRT activation increased from 0 to 4 hours and then plateauing. This pattern was observed across several thresholds of physiologic derangement.ConclusionsIncreasing time to RRT activation was associated in a nonlinear fashion with increased 7-day mortality. This relationship appeared most marked when using a CART score greater than 20 threshold from which to measure time to RRT activation. We suggest that these empirical findings could be used to inform RRT delay definitions in further studies to determine the clinical impact of interventions focused on timely RRT activation.

Project description:ObjectivesDecreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether rapid response team call frequency suffers from decreased utilization at night and how this is associated with patient outcomes.DesignRetrospective analysis of a prospectively collected registry database.SettingNational registry database of inpatient rapid response team calls.PatientsIndex rapid response team calls occurring on the general wards in the American Heart Association Get With The Guidelines-Medical Emergency Team database between 2005 and 2015 were analyzed.InterventionsNone.Measurements and main resultsThe primary outcome was inhospital mortality. Patient and event characteristics between the hours with the highest and lowest mortality were compared, and multivariable models adjusting for patient characteristics were fit. A total of 282,710 rapid response team calls from 274 hospitals were included. The lowest frequency of calls occurred in the consecutive 1 AM to 6:59 AM period, with 266 of 274 (97%) hospitals having lower than expected call volumes during those hours. Mortality was highest during the 7 AM hour and lowest during the noon hour (18.8% vs 13.8%; adjusted odds ratio, 1.41 [1.31-1.52]; p < 0.001). Compared with calls at the noon hour, those during the 7 AM hour had more deranged vital signs, were more likely to have a respiratory trigger, and were more likely to have greater than two simultaneous triggers.ConclusionsRapid response team activation is less frequent during the early morning and is followed by a spike in mortality in the 7 AM hour. These findings suggest that failure to rescue deteriorating patients is more common overnight. Strategies aimed at improving rapid response team utilization during these vulnerable hours may improve patient outcomes.

Dataset Information

A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.

Publications

A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.

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