The implementation of a rapid response team at Memorial Sloan-Kettering Cancer Center: A preliminary report

Abstract

6627 Background: The implementation of a rapid response team (RRT) has become a popular patient safety initiative at many health care institutions during the past decade. To date, there are no studies evaluating the utilization or impact of a rapid response team in a population of cancer patients. We report on our experience implementing such a team at Memorial Sloan-Kettering Cancer Center. Methods: A consecutive cohort of all consults performed by the RRT between July 1st and December 31th, 2006 had the following variables recorded: primary cancer diagnosis, reason for consult, RRT intervention. Outcomes measured were survival to discharge and 30 day survival. Hospital mortality and hospital codes were compared to historical data from 2005 and were adjusted for hospital census. Results: There were 195 consults requested between July 1st and December 31st, 2006. The majority of these patients were on the medical service (124 vs 66 on surgical service). The most common primary malignancies for which the RRT was called arose from the gastrointestinal tract (30.2%), thoracic cavity (12.8%), urologic tract (9.3%), and breast (7.6%). Most consults were requested for compromised respiratory function (n=76), cardiovascular (n=72, 34 hypotension, 23 tachycardia), and neurologic derangements (n=13). 33 patients (16.9%) required transfer to an alternate level of care such as telemetry or the intensive care unit. 121 patients (65%) seen by the RRT survived to discharge however 92 (47%) died within 30 days of an RRT consult. Hospital codes decreased 21% (55 vs 70, p<0.10) and hospital mortality decreased 22% (3.43 deaths per 1,000 discharges vs 4.43 deaths per 1,000 discharges) following implementation of the RRT although these results did not achieve statistical significance. Conclusions: The Rapid Response Team at MSKCC assists in the acute management of hospitalized cancer patients. Many of these patients are critically-ill and are near the end of their oncologic course. Further studies are necessary to better characterize the impact of this resource and determine how it can be utilized most effectively. No significant financial relationships to disclose.