Cost implications of avoidable rapid response call activations in older patients

BACKGROUND: Rapid response calls (RRCs) are designed to appropriately manage clinical deterioration. However, not all RRCs are appropriate due to medical futility or the patient’s wishes. Incidence and costs associated with avoidable-RRC (ARRC) remain underexplored. AIMS: The aim of this study was to describe the incidence and costs of ARRC activations in older patients. METHODS: We retrospectively reviewed RRCs in patients aged ≥80 years over six months. We defined ARRC as RRC activations despite clear documentation confirming not for further RRCs. Data on investigations, equipment and management of each ARRC were analysed. We then micro-costed each ARRC using standard references. RESULTS: Ten percent (25/255) of RRCs were ARRC (mean age 85.6 years) with most patients (88%) admitted under medical teams. Median duration of ARRC was 22 minutes (IQR 7–38 minutes). Palliative care services were underutilised (40%). Most patients (94.4%) died soon after ARRC. The costs for investigations, equipment and management was AUD $2,267.01, opportunity costs were AUD $3,861.55, with a grand total cost of AUD $6,128.56. CONCLUSION: ARRC, noted in 10% of RRCs, are associated with increased time and financial costs. Further research is required to better understand ARRC triggers to reduce the burden of ARRC on patients, carers and hospital staff.