Epidemiology of early Rapid Response Team activation after Emergency Department admission.

2016-02

Mora, Juan Carlos

Schneider, Antoine G

Robbins, Raymond J

Bailey, Michael

Bebee, Bronwyn

Hsiao, Yu-Feng Frank

Considine, Julie

Jones, Daryl A

Bellomo, Rinaldo

Emergency medicine

Hospital Rapid Response Team

Intensive Care Units

Mortality

Triage

Journal Article

0000-0002-1650-8939

10.1016/j.aenj.2015.05.001

Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration. Retrospective case-controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls). Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84 beats/min; p=0.008); after 3h in the ED (91 vs. 80 beats/min; p=0.0007); and at ED discharge (91 vs. 81 beats/min; p=0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2 breaths/min; p=0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02-1.12] for each 1 breath/min increase in RR; and 1.02 [95% CI 1.002-1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86-11.65]; p=0.0003) compared with controls. Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED.

link

Australasian emergency nursing journal : AENJ 2016; 19(1): 54-61

Australasian emergency nursing journal : AENJ