The timing of rapid-response team activations

A multicentre international study

The Medical Emergency Team End-of-Life Care investigators

Research output: Contribution to journalArticleResearchpeer-review

37 Citations (Scopus)

Abstract

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 inhospital 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.

Original languageEnglish
Pages (from-to)15-20
Number of pages6
JournalCritical Care and Resuscitation
Volume15
Issue number1
Publication statusPublished - 2013

Cite this

The Medical Emergency Team End-of-Life Care investigators (2013). The timing of rapid-response team activations: A multicentre international study. Critical Care and Resuscitation, 15(1), 15-20.
The Medical Emergency Team End-of-Life Care investigators. / The timing of rapid-response team activations : A multicentre international study. In: Critical Care and Resuscitation. 2013 ; Vol. 15, No. 1. pp. 15-20.
@article{847d4d10af4f497aacc594f052a124ad,
title = "The timing of rapid-response team activations: A multicentre international study",
abstract = "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 inhospital 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.",
author = "Daryl Jones and Rinaldo Bellomo and Hart, {Graeme K} and Ambica Parma and Gibney, {Noel R T} and Bagshaw, {Sean M} and Gaurav Bhatia and Tim Leong and Glenn Eastwood and Leah Peck and Jonathon Barret and Tracey Bucknall and Ken Hillman and Parr, {Michael J A} and Gabriella J{\"a}derling and David Konrad and Casamento, {Andrew J} and Andrea Doric and Cathryn Street and Graeme Duke and Julie Barbetti and John Prowle and David Crosby and Elisa Licari and Farley, {K J} and Marco Fedi and Fong, {Chun Yew} and Rafidah Atan and Rasa Ruseckaite and Matthew MacPartin and Jayne Stevenson and {\AA}sa Bengtsson and Angaj Ghosh and Christelle Botha and Melissa Kaufmann and Neil Macdonald and {The Medical Emergency Team End-of-Life Care investigators}",
year = "2013",
language = "English",
volume = "15",
pages = "15--20",
journal = "Critical Care and Resuscitation",
issn = "1441-2772",
publisher = "Australasian Medical Publishing Co. Pty Ltd. (AMPCo)",
number = "1",

}

The Medical Emergency Team End-of-Life Care investigators 2013, 'The timing of rapid-response team activations: A multicentre international study', Critical Care and Resuscitation, vol. 15, no. 1, pp. 15-20.

The timing of rapid-response team activations : A multicentre international study. / The Medical Emergency Team End-of-Life Care investigators.

In: Critical Care and Resuscitation, Vol. 15, No. 1, 2013, p. 15-20.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The timing of rapid-response team activations

T2 - A multicentre international study

AU - Jones, Daryl

AU - Bellomo, Rinaldo

AU - Hart, Graeme K

AU - Parma, Ambica

AU - Gibney, Noel R T

AU - Bagshaw, Sean M

AU - Bhatia, Gaurav

AU - Leong, Tim

AU - Eastwood, Glenn

AU - Peck, Leah

AU - Barret, Jonathon

AU - Bucknall, Tracey

AU - Hillman, Ken

AU - Parr, Michael J A

AU - Jäderling, Gabriella

AU - Konrad, David

AU - Casamento, Andrew J

AU - Doric, Andrea

AU - Street, Cathryn

AU - Duke, Graeme

AU - Barbetti, Julie

AU - Prowle, John

AU - Crosby, David

AU - Licari, Elisa

AU - Farley, K J

AU - Fedi, Marco

AU - Fong, Chun Yew

AU - Atan, Rafidah

AU - Ruseckaite, Rasa

AU - MacPartin, Matthew

AU - Stevenson, Jayne

AU - Bengtsson, Åsa

AU - Ghosh, Angaj

AU - Botha, Christelle

AU - Kaufmann, Melissa

AU - Macdonald, Neil

AU - The Medical Emergency Team End-of-Life Care investigators

PY - 2013

Y1 - 2013

N2 - 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 inhospital 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.

AB - 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 inhospital 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.

UR - http://www.scopus.com/inward/record.url?scp=84884876751&partnerID=8YFLogxK

UR - http://search.informit.com.au.ezproxy.lib.monash.edu.au/documentSummary;dn=199431247391390;res=IELHEA

M3 - Article

VL - 15

SP - 15

EP - 20

JO - Critical Care and Resuscitation

JF - Critical Care and Resuscitation

SN - 1441-2772

IS - 1

ER -

The Medical Emergency Team End-of-Life Care investigators. The timing of rapid-response team activations: A multicentre international study. Critical Care and Resuscitation. 2013;15(1):15-20.