Abstract
BackgroundRapid Response Teams (RRTs) are groups of healthcare providers that are used by many hospitals to respond to acutely deteriorating patients admitted to the wards. We sought to identify outcomes of patients assessed by RRTs outside standard working hours.MethodsWe used a prospectively collected registry from two hospitals within a single tertiary care-level hospital system between May 1, 2012, and May 31, 2016. Patient information, outcomes, and RRT activation information were stored in the hospital data warehouse. Comparisons were made between RRT activation during daytime hours (0800–1659) and nighttime hours (1700–0759). The primary outcome was in-hospital mortality, analyzed using a multivariable logistic regression model.ResultsA total of 6023 RRT activations on discrete patients were analyzed, 3367 (55.9%) of which occurred during nighttime hours. Nighttime RRT activation was associated with increased odds of mortality, as compared with daytime RRT activation (adjusted OR 1.34, 95% CI 1.26–1.40, P = 0.02). The time periods associated with the highest odds of mortality were 0600–0700 (adjusted OR 1.30, 95% CI 1.09–1.61) and 2300–2400 (adjusted OR 1.34, 95% CI 1.01–1.56). Daytime RRT activation was associated with increased odds of intensive care unit admission (adjusted OR 1.40, 95% CI 1.31–1.50, P = 0.02). Time from onset of concerning symptoms to RRT activation was shorter among patients assessed during daytime hours (P < 0.001).ConclusionsAcutely deteriorating ward patients assessed by an RRT at nighttime had a higher risk of in-hospital mortality. This work identifies important shortcomings in health service provision and quality of care outside daytime hours, highlighting an opportunity for quality improvement.
Highlights
Rapid Response intensive care unit (ICU) Intensive care unit (Team) (RRTs) are groups of healthcare providers that are used by many hospitals to respond to acutely deteriorating patients admitted to the wards
Patient cohort The Rapid Response Team (RRT) was activated for 6132 discrete patients during the study period
A total of 2656 patients (44.1%) had calls that occurred during daytime hours (0800–1659), and 3367 (55.9%) had calls that occurred during nighttime hours (1700–0759)
Summary
Rapid Response Teams (RRTs) are groups of healthcare providers that are used by many hospitals to respond to acutely deteriorating patients admitted to the wards. Patients admitted to the hospital wards are at risk of deterioration, and recognition of deterioration can be delayed [1, 2]. This puts these patients at increased risk of morbidity and mortality. RRT use has been shown to reduce the incidence of in-hospital cardiac arrest, which has been attributed to early identification and treatment of at-risk patients [6,7,8]. The findings are less robust, RRTs have been shown to improve overall hospital mortality, with particular benefit in reducing the incidence of unexpected inhospital death [10]. RRTs are thought to be useful for early involvement in end-of-life care and ensuring that patient treatment occurs within patient-specific limits of care [11]
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