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Title: Laboratory alerts to guide early intensive care team review in surgical patients: A feasibility, safety, and efficacy pilot randomized controlled trial.
Austin Authors: Bellomo, Rinaldo ;Chan, Matthew;Guy, Christopher;Proimos, Helena;Franceschi, Federica;Crisman, Marco;Nadkarni, Aniket;Ancona, Paolo;Pan, Kevin;Di Muzio, Francesca;Presello, Barbara;Bailey, James;Young, Marcus ;Hart, Graeme K 
Affiliation: School of Medicine, University of Melbourne, Melbourne, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Health and Biomedical Informatics Centre, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Melbourne, Australia
School of Computing and Information Systems, University of Melbourne, Parkville, Melbourne, Australia
IncartaPty Ltd, Melbourne, Australia
Issue Date: 2018
Date: 2018-10-11
Publication information: Resuscitation 2018; 133: 167-172
Abstract: Common blood tests can help identify patients at risk of death, unplanned intensive care unit (ICU) admission, or rapid response team (RRT) call. We aimed to test whether early ICU-team review triggered by such laboratory tests (lab alert) is feasible, safe, and can alter physiological variables, clinical management, and clinical outcomes. In prospective pilot randomized controlled trial in surgical wards of a tertiary hospital, we studied patients admitted for >24 h. We applied a previously validated risk assessment tool to each set of common laboratory tests to identify patients at risk and generate a "lab-alert". We randomly allocated such lab-alert patients to receive early ICU-team review (intervention) or usual care (control). We studied 205 patients (males 54.1%; average age 79 years; 103 randomized to intervention and 102 to usual care). Intervention patients were more likely to trigger RRT activation during their first lab-alert (10.7 vs. 2.0%; P < 0.001) but less likely to receive an allied health referral (18.0% vs. 24.5%; p = 0.007). They were less likely to trigger RRT activation in the 24-h before subsequent alerts (18.4 vs. 22.4%; p = 0.008) and less likely to generate further alerts (204 vs. 320; p < 0.001), but more likely to receive a not for resuscitation or endotracheal intubation status in the 24-h before subsequent alerts (26.6 vs. 17.3%; p = 0.05). Mortality at 24 h was 1.9% for the intervention group vs. 2.9% in the control group (p = 0.63). Finally, overall mortality was 19.4% for intervention patients vs. 23.5% for control patients (p = 0.50). Among surgical patients, lab alerts identify patients with a high mortality. Lab alert-triggered interventions are associated with more first alert-associated RRT activations; more changes in resuscitation status toward a more conservative approach; fewer subsequent alert-associated RRT activations; fewer subsequent alerts, and decreased allied health interventions (ANZCTRN12615000146594).
DOI: 10.1016/j.resuscitation.2018.10.012
ORCID: 0000-0002-1650-8939
Journal: Resuscitation
PubMed URL: 30316952
Type: Journal Article
Subjects: Adverse events
Intensive care
Laboratory tests
Rapid response teams
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