Dataset Information

Predictors of In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample.

ABSTRACT: OBJECTIVES:Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk of death during hospitalization could improve triage to intensive care units and prompt timely reevaluations of goals of care. We sought to identify predictors of in-hospital mortality in patients who are subjects of rapid response team calls and to develop and validate a predictive model for death after rapid response team call. DESIGN:Analysis of data from the national Get with the Guidelines-Medical Emergency Team event registry. SETTING:Two-hundred seventy four hospitals participating in Get with the Guidelines-Medical Emergency Team from June 2005 to February 2015. PATIENTS:282,710 hospitalized adults on surgical or medical wards who were subjects of a rapid response team call. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome was death during hospitalization; candidate predictors included patient demographic- and event-level characteristics. Patients who died after rapid response team were older (median age 72 vs 66 yr), were more likely to be admitted for noncardiac medical illness (70% vs 58%), and had greater median length of stay prior to rapid response team (81 vs 47 hr) (p < 0.001 for all comparisons). The prediction model had an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.78-0.79), with systolic blood pressure, time since admission, and respiratory rate being the most important variables. CONCLUSIONS:Patients who die following rapid response team calls differ significantly from surviving peers. Recognition of these factors could improve postrapid response team triage decisions and prompt timely goals of care discussions.

SUBMITTER: Shappell C

PROVIDER: S-EPMC6044728 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Predictors of In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample.

Shappell Claire C Snyder Ashley A Edelson Dana P DP Churpek Matthew M MM

Critical care medicine 20180701 7

<h4>Objectives</h4>Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk of death during hospitalization could improve triage to intensive care units and prompt timely reevaluations of goals of care. We sought to identify predictors of in-hospital mortality in patients who are subjects of rapid response team calls and to develop ...[more]

PMID: 29293147

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Project description:BACKGROUND:Rapid Response Team (RRT) calls are clinical crises. Clinical and time pressures can hinder effective liaison between staff who call the RRT ('users') and those responding as part of the RRT ('members'). Non-technical skills (NTS) training has been shown to improve communication and cooperation but requires time and financial resources that may not be available in acute care hospitals. Rapid Response System (RRS) re-design, aiming to promote use of NTS, may provide an alternative approach to improving interactions within RRTs and between members and users. METHODS:Re-design of an existing mature RRS was undertaken in a tertiary, metropolitan hospital incorporating the addition of: 1) regular RRT meetings 2) RRT role badges and 3) a structured member-to-user patient care responsibility "hand-off" process. To compare experiences and perceptions of calls, users and members were surveyed pre and post re-design. RESULTS:Post re-design there were improvements in members' understanding of RRT roles (P?=?0.03) and responsibilities (P?<?0.01), and recollection of introducing themselves to users (P?=?0.02). For users, after the re-design, there were improvements in identification of the RRT leader (P?<?0.01), and in the development of clinical plans for patients remaining on the ward at the end of an RRT call (P?<?0.01). However, post-re-design, fewer users agreed that the structured hand-off was useful or that they should be involved in the process. Both members and users reported fewer experiences of conflict at RRT calls post-re-design (both P?<?0.01). CONCLUSION:The RRS re-design yielded improvements in interactions between members in RRTs and between RRT members and users. However, some unintended consequences arose, particularly around user satisfaction with the structured hand-off. These findings suggest that refinement and improvement of the RRS is possible, but should be an ongoing iterative effort, ideally supported by staff training. TRIAL REGISTRATION:NCT01551160. Registered: 12th March 2012.

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.

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Predictors of In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample.

Publications

Predictors of In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample.

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