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The timing of Rapid-Response Team activations: a multicentre international study

Jones, Daryl, Bellomo, Rinaldo, Hart, Graeme K, Parma, Ambica, Gibney, RT Noel, Bagshaw, Sean M, Bhatia, Gaurav, Leong, Tim, Eastwood, Glenn, Peck, Leah, Barret, Jonathon, Bucknall, Tracey, Hillman, Ken, Parr, Michael, Jaderling, Gabriella, Konrad, David, Casamento, Andrew, Doric, Andrea, Street, Cathryn, Duke, Graeme, Barbetti, Julie, Prowle, John, Crosby, David, Licari, Elisa, Farley, KJ, Fedi, Marco, Fong, Chun, Atan, Rafidah, Ruseckaite, Rasa, MacPartin, Matthew, Stevenson, Jayne, Bengtsson, Asa, Ghosh, Angaj, Botha, Christelle, Kaufmann, Melissa and MacDonald, Neil 2013, The timing of Rapid-Response Team activations: a multicentre international study, Critical care and resuscitation, vol. 15, no. 1, pp. 15-20.

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Title The timing of Rapid-Response Team activations: a multicentre international study
Author(s) Jones, Daryl
Bellomo, Rinaldo
Hart, Graeme K
Parma, Ambica
Gibney, RT Noel
Bagshaw, Sean M
Bhatia, Gaurav
Leong, Tim
Eastwood, Glenn
Peck, Leah
Barret, Jonathon
Bucknall, TraceyORCID iD for Bucknall, Tracey orcid.org/0000-0001-9089-3583
Hillman, Ken
Parr, Michael
Jaderling, Gabriella
Konrad, David
Casamento, Andrew
Doric, Andrea
Street, Cathryn
Duke, Graeme
Barbetti, Julie
Prowle, John
Crosby, David
Licari, Elisa
Farley, KJ
Fedi, Marco
Fong, Chun
Atan, Rafidah
Ruseckaite, Rasa
MacPartin, Matthew
Stevenson, Jayne
Bengtsson, Asa
Ghosh, Angaj
Botha, Christelle
Kaufmann, Melissa
MacDonald, Neil
Journal name Critical care and resuscitation
Volume number 15
Issue number 1
Start page 15
End page 20
Total pages 6
Publisher Australasian Medical Publishing Company
Place of publication Sydney, NSW
Publication date 2013-03
ISSN 1441-2772
Keyword(s) Hospital Rapid Response Team
Aged
Time Factors
Prospective Studies
Middle Aged
Male
Internationality
Humans
Female
80 and over
Summary Background:
Most studies of Rapid-Response Teams (RRTs) assess their effect on outcomes of all hospitalised patients. Little information exists on RRT activation patterns or why RRT calls are needed. Triage error may necessitate RRT review of ward patients shortly after hospital admission. RRT diurnal activation rates may reflect the likely frequency of caregiver visits.

Objectives:
To study the timing of RRT calls in relation to time of day and day of week, and their frequency and outcomes in relation to days after hospital admission.

Methods:
We prospectively studied RRT calls over 1 month in seven hospitals during 2009, collecting data on patient age, sex, admitting unit, admission source, limitations of medical therapy (LOMTs), and admission and discharge dates. We assessed the timing of RRT calls in relation to hospital admission and circadian variation; and differences in characteristics and outcomes of calls occurring early (Days 0 and 1) versus late (after Day 7) after hospital admission.

Results:
There were 652 RRT calls for 518 patients. Calls were more likely on Mondays (P=0.018) and during work hours (P<0.0001) but less likely on weekends (P=0.003) or overnight (P<0.001). There were 177 early calls (27.1%) and 198 late calls (30.4%). Early calls involved younger patients (median ages, 67.5 years [early calls] v 73 years [late calls]; P= 0.01), fewer LOMTs (P=0.029), and lower in hospital mortality (12.8% [early calls] v 32.3% [late calls]; P<0.0001). The mortality difference remained in patients without LOMTs (5.6% [early calls] v 19.6% [late calls]; P=0.003).

Conclusions:
About one-quarter of RRT calls occurred shortly after hospital admission, and were more common when caregivers were around. Early calls may partially reflect suboptimal triage, though the associated mortality appeared low. Late calls may reflect suboptimal end-of-life care planning, and the associated mortality was high. There is a need to further assess the epidemiology of RRT calls at different phases of the hospital stay.
Language eng
Field of Research 110399 Clinical Sciences not elsewhere classified
111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2013, Australasian Medical Publishing Company
Persistent URL http://hdl.handle.net/10536/DRO/DU:30061171

Document type: Journal Article
Collection: School of Nursing and Midwifery
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Created: Mon, 03 Mar 2014, 12:27:07 EST by Nicky Hewitt

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