Enhanced end-of-life care associated with deploying a rapid response team: a pilot study

Rodrigo Vazquez, Cristina Gheorghe, Artur Grigoriyan, Tatsiana Palvinskaya, Yaw Amoateng-Adjepong, Constantine A Manthous
Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine 2009, 4 (7): 449-52

HYPOTHESIS: Institution of a rapid response team (RRT) improves patients' quality of death (QOD).

SETTING: A 425-bed community teaching hospital.

PATIENTS: : All medical-surgical patients whose end-of-life care was initiated on the hospital wards during the 8 months before (pre-RRT) and after (post-RRT) actuation.

STUDY DESIGN: Retrospective cohort study.

METHODS: Medical records of all patients were reviewed using a uniform data abstraction tool. Demographic information, diagnoses, physiologic and laboratory data, and outcomes were recorded.

RESULTS: A total of 197 patients died in both the pre-RRT and post-RRT periods. There were no differences in age, sex, advance directives, ethnicity, or religion between groups. Restorative outcomes, including in-hospital mortality (27 vs. 30/1000 admissions), unexpected transfers to intensive care (17 vs. 19/1000 admissions) and cardiac arrests (3 vs. 2.5/1000 admissions) were similar during the 2 periods. Outcomes, including formal comfort care only orders (68 vs. 46%), administration of opioids (68 vs. 43%), pain scores (3.0 +/- 3.5 vs. 3.7 +/- 3.2), patient distress (26 vs. 62%), and chaplain visits (72 vs. 60%), were significantly better in the post-RRT period compared to the pre-RRT period (all P < 0.05). During the post-RRT period, 61 patients died with RRT care and 136 died without RRT care. End-of-life care outcomes were similar for these groups except more RRT patients had chaplain visits proximate to their deaths (80% vs. 68%; P = 0.0001).

CONCLUSIONS: Institution of an RRT in our hospital had negligible impact on outcomes of patients whose goal was restorative care. Deployment of the RRT was associated with generally improved end-of-life pain management and psychosocial care.

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