Mortality of rapid response team patients in Australia: a multicentre study

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Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine 2013, 15 (4): 273-8

BACKGROUND: Most studies of the rapid response team (RRT) investigate the effect of introducing an RRT on outcomes of all hospitalised patients. Less information exists on RRT patient epidemiology, or changes in RRT call numbers with time.

OBJECTIVES: To estimate the inhospital mortality of patients subject to RRT review, the proportion of inhospital deaths reviewed by the RRT, and changes in annual RRT call numbers with time.

METHOD: Retrospective observational study in adult RRT equipped Australian hospitals for up to 10 years (2000-2009).

PARTICIPANTS AND OUTCOME MEASURES: Thirty-four per cent (35/102) of the Australian adult RRT-equipped hospitals provided annual hospital admissions and deaths, intensive care unit admissions and RRT calls. They also provided the number of patients reviewed by the RRT and the number of inhospital deaths in such patients.

RESULTS: Over the study period, there were 4.91 million hospital admissions, 196 488 ICU admissions and 99 377 RRT calls. Most data arose from Victoria, New South Wales and Western Australia, and from public tertiary hospitals. Among the 27 hospitals contributing at least 4 years of data, annual RRT calls per 1000 admissions was higher in the last year compared with the first year of data submission in 23 hospitals (range of increase, 11.9%- 777.4%; median, 90%; interquartile range, 40%-180%). In the remaining four hospitals, annual RRT calls per 1000 admissions were lower in the last year compared with the first year (range of decrease, - 5.5% to - 29.8%). Among the 70 924 RRT patients for whom the outcome was known, there were 17 260 deaths (24.3%). We calculate that the RRT reviewed 17 260 of 79 476 patients (21.7%) who died in hospital over the study period. In the 2008-09 financial year, there were 18 800 RRT calls for at least 14 743 patients.

CONCLUSIONS: Annual RRT calls are increasing in many Australian hospitals, and now affect more than 14 700 patients annually. Inhospital mortality of RRT patients is about 25%, and about 20% of patients who die in hospital are reviewed by the RRT. Further research is needed to understand the reason for the high inhospital mortality of RRT patients.

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