The mortality associated with review by the rapid response team for non-arrest deterioration: a cohort study of acute hospital adult patients

Roger J Smith, John D Santamaria, David A Reid, Espedito E Faraone
Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine 2014, 16 (2): 119-26

OBJECTIVES: To compare the admission characteristics, discharge destination and mortality of patients reviewed by the rapid response team (RRT) for deterioration with those of other hospital patients; and to determine the association between RRT review for deterioration and mortality.

DESIGN, SETTING AND PATIENTS: Acute admissions of adult patients to a tertiary hospital between 1 January 2008 and 31 December 2011 were identified from administrative data. Data for each patient's first admission were merged with RRT data on the first RRT event of each admission, if any. RRT events involving cardiac arrest were classified as arrest events and all others as deterioration events.

RESULTS: Of 43 385 patients in the cohort, 1117 (2.57%) had RRT review for deterioration and 91 (0.21%) for cardiac arrest. Deterioration events occurred a median of 3.23 days after admission. Advanced treatments were instituted in 38.59% of deterioration events, and a new not-for resuscitation order for 5.55%. Compared with those not reviewed by the RRT, patients in the deterioration group were older (median, 70 v 60 years, P < 0.001) and had a higher Charlson comorbidity index (median, 1 v 0, P < 0.001). They also more often died in hospital (18.80% v 1.42%, P < 0.001) or were discharged to another hospital (37.51% v 13.39%, P < 0.001) and more often died in the 90 days after admission (24.44% v 3.48%, P < 0.001). Their adjusted odds ratio of death in the 90 days after admission was 5.85 (95% CI, 4.97-6.89, P < 0.001).

CONCLUSION: Patients reviewed for deterioration were older and had greater comorbidity than patients the RRT was not called to review. RRT review for deterioration was an independent risk factor for mortality.

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