85 Frequency of Early Rapid Response Team Activation in Emergency Department Patients With Missing Vital Signs

Abstract

Abnormal vital signs (VS) in the emergency department (ED) have been associated with early rapid response team (eRRT) activation after admission. The absence of at least one VS in inpatients has been linked to adverse events. We postulated that patients for whom VS are missing at the time of transfer to the floor might also be at risk for deterioration and eRRT activation. Our primary objective was to document the association of eRRT within 6 hours of admission from the ED with missing VS just before admission. Secondary objectives were to explore the association between missing VS in the ED and different diagnoses as well as length of hospitalization. A retrospective observational study was conducted on RRT activations for the time period between January 1, 2017-June 30, 2017 in adult patients admitted from the ED to a regular floor at a single health center. Study sample included patients who were identified for activation within the first 6 hours of admission. Exclusions included obstetric, pediatric and mental health patients. To assess the association of variables, bivariate analyses were performed to summarize findings using frequencies and percentages for categorical variables and an association was examined with Chi-squared tests where appropriate, otherwise Fisher’s exact tests were used. For continuous variables, measured characteristics were summarized using means and compared by t tests and Wilcoxon tests for normally and non-normally distributed data, respectively. A total of 395 patients were identified to meet inclusion criteria. The most commonly undocumented VS was temperature (290/395 patients). Out of 395 patients who had RRT activation within 6 hours of arrival to the floor, 25 patients (6.33%) with a missing blood pressure (BP) at time of admission (p=0.001) and 32 (8.1%) with a missing heart rate (HR) (p=0.02) had a significantly higher association with RRT activation within 1 hour. Moreover, there was an increased mean length of hospitalization with the addition of 1 day in patients with a missing BP (7.3 vs 6, p=0.03) and approximately 1.5 days in patients with a missing HR (7.52 vs 5.97, p=0.04). Of 33 patients (8.35%) with sepsis who had RRT activation, 6 were missing HR (p=0.01), 7 were missing BP (p=0.002), and 9 were missing oxygen saturation (p<0.001). Compared to non-sepsis patients, more sepsis patients (61%) had RRT activation within 2 hours of arrival to floor (p=0.01). There is a statistically significant association between undocumented BP and HR at time of admission from the ED with RRT activation within 6 hours of arrival to the floor as well as with increased length of hospitalization. Patients diagnosed with sepsis in the ED who had RRT activation tended to have missing VS prior to admission, namely HR, BP, and oxygen saturation and over half of sepsis patients had RRT activation within 2 hours after arriving to the floor. A larger cohort may further support the suggestion that a complete set of VS at the time of transfer to the medical ward should be obtained and reviewed before leaving the ED to minimize risk of eRRT.Tabled 1Patient Characteristics (n=395)CharacteristicCategoriesn (%)Age in years≤4048 (12.2)41-79248 (62.7)≥8099 (25.1)SexMale185 (46.8)Female210 (53.2)RaceWhite251 (63.5)Black124 (31.4)Other20 (5.1)ComorbiditiesNeurologic107 (27.1)Cardiovascular200 (50.6)Pulmonary97 (24.6)Gastrointestinal127 (32.2)Renal/Genitourinary75 (19.0)Hematologic/Infectious Disease85 (21.5) Open table in a new tab