TOO LITTLE TOO LATE: A LOOK AT RAPID RESPONSES

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: In 2008 as part of the National Patient Safety goal the Joint Commission required hospitals to implement systems that would enable “health care team members to directly request additional help from specially trained individuals when a patient’s condition is deteriorating.” With this mandate rapid response systems became a nationwide phenomenon. The goal of a rapid response team (RRT) is to intervene early on patients who are having clinical deterioration to prevent cardiopulmonary arrest. We reviewed our institution’s data to see how well we are doing in terms of meeting this mandate. We found the most common reason for RRT activation was alteration of mental status (AMS). We feel that AMS is a late manifestation of a disease process and that patients for whom RRT is activated for AMS will have a worse outcome. We reviewed the charts of the patients for whom RRT was activated for AMS to elucidate the cause of the alteration. METHODS: A retrospective chart review of all RRT activations in one calendar year were reviewed. RRT activations for AMS were reviewed to further elucidate the cause of the AMS. These causes were sorted to be primary neurologic, respiratory, sepsis or other. The causes were sorted to be primary neurologic, respiratory, infectious, or other, and the ultimate disposition of those patients was determined and if the patient expired. RESULTS: In 2016 there were a total of 658 RRT activations; of those 359 (53%) were for AMS. Preliminary review of 201 charts showed 37 (18.4%) were caused by respiratory failure and 40 (19.9%) were secondary to sepsis. 35% of those with respiratory failure as a cause of their AMS and 45% with sepsis as the cause of AMS were transferred to Intensive Care Unit (ICU). Furthermore, 51% of patients with AMS due to a respiratory cause and 30% of patients with AMS due to sepsis died. CONCLUSIONS: Alteration of mental status is a manifestation of many disease processes, particularly at a late-stage. Recognition of these disease processes earlier in the course is important to decrease morbidity and mortality. Our review showed that AMS was frequently caused for non-neurologic processes and was often associated with poor outcomes. In our cohort, a significant proportion of patients had infectious and respiratory causes for their AMS and had a high proportion required ICU admission or died. These findings show that despite the high numbers of rapid responses called, we are still missing early deterioration of vulnerable patients. CLINICAL IMPLICATIONS: Rapid responses called for altered mental status may be a late manifestation of many disease processes leading to worse outcomes. This information can be used to train clinicians in earlier recognition of these diseases to help prevent morbidity and mortality. DISCLOSURES: No relevant relationships by Ayelet Hilewitz, source=Web Response No relevant relationships by Mahmuda Khan, source=Web Response No relevant relationships by Courtney Kluger, source=Web Response No relevant relationships by Kevin Lazo, source=Web Response No relevant relationships by Belinda Lee, source=Web Response No relevant relationships by Diandra Nesbitt, source=Web Response No relevant relationships by Neeti Pradeep, source=Web Response No relevant relationships by Adey Tsegaye, source=Web Response