Abstract 034: Rapid Response Activation and In-hospital Mortality

Abstract

Introduction: The institute for Healthcare Improvement (IHI) encouraged the implementation of rapid response teams (RRT) in hospitals with the aim of early detection of patient deterioration. The rapid response system (formerly Medical Emergency Team (MET)) has been in place at our institution since 2005; however, data regarding its utilization and outcomes are scarce. Methods: Data regarding patient characteristics and reasons for activating RRTs were collected from hospital telephone operator records and patient medical records. The study was IRB exempt. Results: During a 2 month period (08/09/16 to 10/09/16), the RRT was activated 96 times on 93 patients. Of those, 31 RRT activations (32%) took place within 24 hours of admission to the hospital. The average age of these patients was 64, and 59% were male. Fifty-four RRT activations (56%) were called during the daytime shift (from 7 am to 7 pm). The reason for calling the RRT was mentioned in the hospital operators paging message in 67/96 cases. The most common reasons for activating the system were: Respiratory distress 34/67 (51%), mental status changes 9/67 (13%), and tachycardia 9/67 (13%). Other less common causes were seizures 3/67 (4.5%), chest pain 3/67 (4.5%), hypotension 3/67 (4.5%), and falls 2/67 (3%). Twenty patients (22%) on whom an RRT was called, died during the same hospital admission. The mortality rate of those patients was 6 folds higher than the general In-hospital mortality rate. The average age of the patients who died was 63. Respiratory distress was the most common cause of RRT activation among patients who died 10/20 (50%). Conclusion: Patients admitted to the hospital who had an RRT activation had a six fold risk of dying during the same admission. The majority of RRT activations were for respiratory distress, mental status changes, and tachycardia, and one-third occurred within the first 24 hours of admission. Routine review of RRT data can help target areas for improvement, specifically, factors contributing to in-hospital mortality.