Rapid Response Team Activation Research Articles

Etiology and Timing of Postoperative Rapid Response Team Activations.

In this retrospective cohort study we sought to evaluate the association between the etiology and timing of rapid response team (RRT) activations in postoperative patientsat a tertiary care hospital in the southeastern United States. From 2010 to 2016, there were 2,390 adult surgical inpatients with RRT activations within seven days of surgery. Using multivariable linear regression, we modeled the correlation between etiology of RRT and timing of the RRT call, as measured from the conclusion of the surgical procedure. We found that respiratory triggers were associated with an increase in time after surgical procedure to RRT of 10.6h compared to activations due to general concern (95% CI 3.9 - 17.3) (p = 0.002). These findings may have an impact on monitoring of postoperative patients, as well as focusing interventions to better respond to clinically deteriorating patients.

Implementation of extended possibility for CPAP in general wards: A quality inter-professional intervention project

Introduction and objectivesIn a Danish Hospital, 70% of all activations of the rapid response team (RRT) in 2016 were related to adult patients with respiratory insufficiency. The most frequent RRT intervention was continuous positive airway pressure (CPAP). However, there was no systematic follow-up and patients could not receive CPAP outside of daytime hours. The aim of the study was to implement and evaluate a CPAP intervention to improve healthcare. Patients and methodsA quality inter-professional intervention project was conducted. The interventions consisted of: theoretical and practical education in respiratory insufficiency (including use of CPAP) of nurses and physicians from the general wards, physiotherapists and staff from the RRT; development of an instruction leaflet and video; an update of the existing guidelines. The interventions entailed patients being able to receive CPAP a minimum of 3 times for 5–10min within a 24-h period. All RRT activations were registered and compared in a before–after evaluation of the intervention. Additionally, all staff groups received an electronic questionnaire after implementation. ResultsAfter implementation, respiratory insufficiency was still the highest primary course for RRT activation. The use of CPAP increased, and the number of patients needing a transfer to the intensive care unit decreased. The response rate for the questionnaire was 44% (203 out of 465), and staff experienced new competences, improved inter-professional cooperation and improved healthcare. However, a substantial number of staff did not feel sufficiently trained or that the intervention was well-implemented. ConclusionThe intervention entailed new competences for the staff, as well as improved system performance, inter-professional cooperation and healthcare. However, there is a need for continuous focus on the intervention.

Quantifying the incidence of clinically significant respiratory depression in women with and without obesity class III receiving neuraxial morphine for post-cesarean analgesia: a retrospective cohort study

BackgroundObesity is a suspected risk factor for respiratory depression following neuraxial morphine for post-cesarean analgesia, however monitoring guidelines for obese obstetric patients are based on small, limited studies. We tested the hypothesis that clinically significant respiratory depression following neuraxial morphine occurs more commonly in women with body mass index (BMI) ≥40 kg/m2 compared with BMI <40 kg/m2. MethodsWe conducted a single-center, retrospective chart review (2006–2017) of obstetric patients with clinically significant respiratory depression following neuraxial morphine, defined as: (1) opioid antagonist administration; (2) rapid response team activation (initiated in April 2010); or (3) tracheal intubation due to a respiratory event. The incidence of respiratory depression was compared between women with BMI ≥40 kg/m2 and BMI <40 kg/m2. ResultsIn total, 11 327 women received neuraxial morphine (n=1945 BMI ≥40 kg/m2; n=9382 BMI <40 kg/m2). Women with BMI ≥40 kg/m2 had higher rates of sleep apnea, hypertensive disorders, and magnesium administration. Sixteen cases of clinically significant respiratory depression occurred within seven days postpartum. The incidence did not significantly differ between groups (odds ratio 2.2, 95% CI 0.6 to 6.9, P=0.174). Neuraxial morphine was not deemed causative in any case, however women with BMI ≥40 kg/m2 had higher rates of tracheal intubation unrelated to neuraxial morphine (2/1945 vs. 0/9382, P=0.029). ConclusionsRespiratory depression in this population is rare. A larger sample (∼75 000) is required to determine whether the incidence is higher with BMI ≥40 kg/m2. Tracheal intubation was higher among the BMI ≥40 kg/m2 cohort, likely due to more comorbidities.

Impact of COVID-19 on inpatient clinical emergencies: A single-center experience

AimDetermine changes in rapid response team (RRT) activations and describe institutional adaptations made during a surge in hospitalizations for coronavirus disease 2019 (COVID-19). MethodsUsing prospectively collected data, we compared characteristics of RRT calls at our academic hospital from March 7 through May 31, 2020 (COVID-19 era) versus those from January 1 through March 6, 2020 (pre-COVID-19 era). We used negative binomial regression to test differences in RRT activation rates normalized to floor (non-ICU) inpatient census between pre-COVID-19 and COVID-19 eras, including the sub-era of rapid COVID-19 census surge and plateau (March 28 through May 2, 2020). ResultsRRT activations for respiratory distress rose substantially during the rapid COVID-19 surge and plateau (2.38 (95% CI 1.39–3.36) activations per 1000 floor patient-days v. 1.27 (0.82–1.71) during the pre-COVID-19 era; p=0.02); all-cause RRT rates were not significantly different (5.40 (95% CI 3.94–6.85) v. 4.83 (3.86–5.80) activations per 1000 floor patient-days, respectively; p=0.52). Throughout the COVID-19 era, respiratory distress accounted for a higher percentage of RRT activations in COVID-19 versus non-COVID-19 patients (57% vs. 28%, respectively; p=0.001). During the surge, we adapted RRT guidelines to reduce in-room personnel and standardize personal protective equipment based on COVID-19 status and risk to providers, created decision-support pathways for respiratory emergencies that accounted for COVID-19 status uncertainty, and expanded critical care consultative support to floor teams. ConclusionIncreased frequency and complexity of RRT activations for respiratory distress during the COVID-19 surge prompted the creation of clinical tools and strategies that could be applied to other hospitals.

Continuous Physiological Monitoring Improves Patient Outcomes.

General patient acuity is increasing in the United States, with more patients having multiple comorbidities and acute-on-chronic conditions. Hospitalizations may also be complicated by serious adverse events, often unrelated to the admitting medical diagnosis. In our facility, the late detection of patient deterioration on general medical units often resulted in increased length of stay (LOS) in the ICU and poor patient outcomes. The purpose of this project was to improve patient surveillance and better identify early signs of patient deterioration through the use of continuous vital sign monitoring technology. To improve detection of patient deterioration, a nurse-led monitoring and response system was developed using a wearable, wireless device for continuous vital sign surveillance. The patient data the device provided was used with early warning scores and sepsis screening protocols for timely goal-directed interventions. Ninety-seven percent of patient deterioration events were recognized and treated as a result of this continuous monitoring and response system. Rapid response team activations decreased by 53% between baseline and the intervention period. LOS among patients transferred to the ICU decreased from 2.82 to 2.19 days. Nurse satisfaction with use of the continuous monitoring device was positive, with 74% of nurses surveyed reporting that information provided by the device enhanced decision-making. New technology for patient surveillance, in this case a nurse-led monitoring and response system, can be successfully integrated into general care practice. Use of the nurse-led response system helped nurses recognize early signs of deterioration and continue meaningful patient interactions.

Code status at time of rapid response activation — Impact on escalation of care?

BackgroundA code status documents the decision to receive or forgo cardiopulmonary resuscitation in the event of cardiac arrest. For patients who undergo a rapid response team activation (RRT) for possible escalation to an intensive care unit (ICU), the presence or absence of a code status represents a critical inflection point for guiding care decisions and resource utilization. This study characterizes the prevalence of code status at the time of RRT and how code status at RRT affects rates of intensive treatments in the ICU. MethodsWe conducted a single-center retrospective cohort study of 895 rapid response activations occurring over six months. The study included all rapid response team activations for non-obstetric adult inpatients documented in the patient chart. All data was obtained through retrospective chart review. STROBE reporting guidelines were followed. ResultsAt the time of RRT activation, 56% of patients had a documented code status. Code status prevalence was much higher among medical rather than surgical services (74% vs. 13%). For patients escalated to the ICU, having a DNR code status at RRT was not associated with decreased odds of receiving cardioactive medications or advanced respiratory support. Before RRT activation, palliative care utilization was low (9%) but more than doubled after RRT (24% before discharge). ConclusionsBarely half of the patients had an active code status at the time of RRT activation. Similar rates of invasive ICU treatments among full code and DNR patients suggest that documented code statuses do not reflect in-depth goals of care discussions, nor does it guide medical teams caring for the patient at times of decompensation.

A Quality Improvement Initiative to Reduce Unnecessary Rapid Responses Using Early Warning Scores

The Pediatric Early Warning Score (PEWS) is an evidence-based tool that allows early collaborative assessment and intervention for a rapid response team (RRT) activation. The goal of our quality improvement initiative was to reduce the percentage of unnecessary RRT activations by 50% over 2 years without increasing PICU transfers or compromising patient safety and timely evaluation. A PEWS system replaced preexisting vital signs-based pediatric RRT criteria and was modified through plan-do-study-act cycles. Unnecessary RRT activations, total RRT activation rate, transfers to the PICU, total clinical interventions performed per RRT, and missed RRT activation rate were compared between intervention periods. Likert scale surveys were administered to measure satisfaction with each modification. There was a significant decrease in the percentage of unnecessary RRT activations from 33% to 3.5% after the implementation of the PEWS and modified-PEWS systems (P < .05). The RRT activation rate decreased from 22.6 to 13.3 RRT activations per 1000 patient care days after implementation of the PEWS and modified-PEWS systems (P < .05), without changes in PICU transfer rates. Physicians reported that the PEWS system improved nursing communication and accuracy of RRT criteria (P < .05). Nursing reported that the PEWS system improved patient management and clinical autonomy (P < .05). The PEWS systems have been an effective means of identifying deteriorating pediatric patients and reducing unnecessary RRT activations. The new system fosters collaboration and communication at the bedside to prevent acute deterioration, perform timely interventions, and ultimately improve patient safety and outcomes.

Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system.

The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously. To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation. This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls. The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001). The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.

Improved outcomes after implementation of a specialized pediatric cardiac rapid response team.

The efficacy of a specialized pediatric cardiac rapid response team is unknown. We hypothesized that a specialized cardiac rapid response team would facilitate team-wide communication between the cardiac stepdown unit and cardiac intensive care unit (ICU) teams and improve patient care. A specialized pediatric cardiac rapid response team was implemented in June 2015. All pediatric cardiac rapid response team activations and outcomes from implementation through December 2018 were reviewed. Cardiac arrests and unplanned transfers to the cardiac ICU were indexed to 1000 patient-days to account for inpatient volume trends and evaluated over time. There were 202 cardiac rapid response team activations in 108 unique patients during the study period. After implementation of the pediatric cardiac rapid response team, unplanned transfers from the cardiac stepdown unit to the cardiac ICU decreased from 16.8 to 7.1 transfers per 1000 patient days (p = 0.012). The stepdown unit cardiac arrest rate decreased from 1.2 to 0.0 arrests per 1000 patient-days (p = 0.015). There was one death on the cardiac stepdown unit in the 5 years since the implementation of the cardiac rapid response team, compared to four deaths in the previous 5 years. A reduction in unplanned cardiac ICU transfers, cardiac arrests, and mortality on the cardiac stepdown unit has been observed since the implementation of a specialized pediatric cardiac rapid response team. A specialized cardiac rapid response team may improve communication and empower the interdisciplinary care team to escalate care for patients experiencing clinical decline.

Can Early Warning Systems Enhance Detection of High Risk Patients by Rapid Response Teams?

We sought to evaluate if incorporating an early warning system (EWS), the Visensia Safety Index (VSI) and the National Early Warning Systems 2 (NEWS2), may lead to earlier identification of rapid response team (RRT) patients. This was a retrospective study (2015-2018) of patients experiencing RRT activation within a tertiary care network. We evaluated the proportion of patients with an EWS alert prior to RRT activation and their associated outcomes (primary: hospital mortality). There were 6,346 RRT activations over the study period. Of these, 2042 (50.8%) patients would have had a VSI alert prior to RRT activation, with a median advanced time of 3.6 (IQR 0.5-12.8) hours, compared to 2351 (58.4%) patients and 9.8 (IQR 2.0-18.7) hours for NEWS2. Patients with a potential alert prior to RRT activation had an increased odds of mortality for both VSI (OR 1.2, 95%CI 1.1-1.3) and NEWS2 (OR 2.7, 95% CI 2.4-3.1). Prognostic accuracy for hospital mortality was similar between groups. Utilization of an EWS by an RRT has potential to provide earlier recognition of deterioration and mortality risk among hospitalized inpatients.

Rapid response team nurses' attitudes and barriers to the rapid response system: A multicentre survey

Despite wide implementation of rapid response teams (RRTs), no published data exist on RRT nurses' attitudes and barriers to the rapid response system (RRS). We piloted a 5-point Likert-type scale questionnaire among all Finnish university hospitals' RRT nurses with optional open-ended comments. The impact of more frequent RRT participation was further investigated. The response rate was 46% (n=176/379, 34%-93% between hospitals). The respondents median experience on a RRT was three years (0.8-5) and median participation was two (1-5) RRT activations per month. Over 90% of the RRT nurses felt that RRS prevented cardiac arrests and improved patient safety. Nurses with five or more RRT activations/month believed their critical care skills had improved through these duties (94% vs 71%, P=.001), considered their RRT work meaningful (94% vs 76%, P=.005) and wanted to continue as RRT nurses (91% vs 74%, P=.015) more often than nurses with less than five RRT activations/month. In addition to the infrequent RRT participation, further negative experiences with RRS among the RRT nurses included feeling overworked (68%) or undercompensated (94%) for the RRT duties and conflicts between RRT and ward doctors (25%). RRT nurses consider their work important and believe it fosters improved critical care skills; these beliefs are emphasized among those with more frequent RRT participation. Infrequent RRT participation, feeling overworked and/or undercompensated and conflicts between RRT and ward doctors may present barriers for successful RRS among RRT nurses.

Effectiveness of an Electronic Communication Tool on Transitions in Care From the Intensive Care Unit: Protocol for a Cluster-Specific Pre-Post Trial.

BackgroundTransitions in care are vulnerable periods in health care that can expose patients to preventable errors due to incomplete or delayed communication between health care providers. Transitioning critically ill patients from intensive care units (ICUs) to other patient care units (PCUs) is particularly risky, due to the high acuity of the patients and the diversity of health care providers involved in their care. Instituting structured documentation to standardize written communication between health care providers during transitions has been identified as a promising means to reduce communication breakdowns. We developed an evidence-informed, computer-enabled, ICU-specific structured tool—an electronic transfer (e-transfer) tool—to facilitate and standardize the composition of written transfer summaries in the ICUs of one Canadian city. The tool consisted of 10 primary sections with a user interface combination of structured, automated, and free-text fields.ObjectiveOur overarching goal is to evaluate whether implementation of our e-transfer tool will improve the completeness and timeliness of transfer summaries and streamline communications between health care providers during high-risk transitions.MethodsThis study is a cluster-specific pre-post trial, with randomized and staggered implementation of the e-transfer tool in four hospitals in Calgary, Alberta. Hospitals (ie, clusters) were allocated randomly to cross over every 2 months from control (ie, dictation only) to intervention (ie, e-transfer tool). Implementation at each site was facilitated with user education, point-of-care support, and audit and feedback. We will compare transfer summaries randomly sampled over 6 months postimplementation to summaries randomly sampled over 6 months preimplementation. The primary outcome will be a binary composite measure of the timeliness and completeness of transfer summaries. Secondary measures will include overall completeness, timeliness, and provider ratings of transfer summaries; hospital and ICU lengths of stay; and post-ICU patient outcomes, including ICU readmission, adverse events, cardiac arrest, rapid response team activation, and mortality. We will use descriptive statistics (ie, medians and means) to describe demographic characteristics. The primary outcome will be compared within each hospital pre- and postimplementation using separate logistic regression models for each hospital, with adjustment for patient characteristics.ResultsParticipating hospitals were cluster randomized to the intervention between July 2018 and January 2019. Preliminary extraction of ICU patient admission lists was completed in September 2019. We anticipate that evaluation data collection will be completed by early 2021, with first results ready for publication in spring or summer 2021.ConclusionsThis study will report the impact of implementing an evidence-informed, computer-enabled, ICU-specific structured transfer tool on communication and preventable medical errors among patients transferred from the ICU to other hospital care units.Trial RegistrationClinicalTrials.gov NCT03590002; https://www.clinicaltrials.gov/ct2/show/NCT03590002International Registered Report Identifier (IRRID)DERR1-10.2196/18675

1103: Characteristics and Outcomes of Early Pediatric Rapid Response Team Activations

1103: Characteristics and Outcomes of Early Pediatric Rapid Response Team Activations

1108: Secondary Analysis of Diagnostic Error Rate in Patients Requiring Rapid Response Team Activation

Pinevich, Yuliya1; Soleimani, Jalal1; Huang, Chanyan1; Herasevich, Svetlana1; Barwise, Amelia1; Dong, Yue1; Herasevich, Vitaly1; Gajic, Ognjen1; Pickering, Brian1 Author Information

Rapid response team trigger modifications: are we using them safely?

Rapid response teams (RRT) were first proposed as a means of reducing inpatient morbidity and mortality. Modifying RRT activation triggers poses a potential risk for delayed recognition of a deteriorating patient. Trigger modifications have not been validated for safety. To determine if RRT trigger modifications are associated with: increased frequency of recurrent RRT activation; increased length of stay (LOS); increased intensive care admission; and increased in-hospital mortality. A retrospective audit of all RRT activations occurring at the Launceston General Hospital (LGH) over an 18-month period was performed. Rate of recurrent RRT activations did not decrease with the use of trigger modifications around the time of RRT activation, and for patients with two modifications, the frequency increased (1.98 vs 1.32, P = 0.007). LGH LOS increased for patients with any trigger modifications compared to those with none (11 vs 9, P = 0.0002), and for patients with two modifications (11.5 vs 9, P = 0.010). Total hospital LOS increased for patients with any modifications compared to patients with none (12 vs 10, P = 0.002). There was no significant association between trigger modifications and frequency of intensive care unit admission. The relative risk of in-hospital death increased with increasing numbers of trigger modifications (relative risk 1.38-4.89). Trigger modifications are associated with increased hospital LOS and increased rate of in-hospital death and do not reduce the number of recurrent events. For patients in whom escalation of care is not appropriate, the presence of multiple trigger modifications at the time of an RRT activation may be a useful trigger for conversations around goals of care.

Predictors of mortality and cost among surgical patients requiring rapid response team activation.

Prior studies of rapid response team (RRT) implementation for surgical patients have demonstrated mixed results with respect to reductions in poor outcomes. The aim of this study was to identify predictors of in-hospital mortality and hospital costs among surgical inpatients requiring RRT activation. We analyzed data prospectively collected from May 2012 to May 2016 at The Ottawa Hospital. We included patients who were at least 18 years of age, who were admitted to hospital, who received either preoperative or postoperative care, and and who required RRT activation. We created a multivariable logistic regression model to describe mortality predictors and a multivariable generalized linear model to describe cost predictors. We included 1507 patients. The in-hospital mortality rate was 15.9%. The patient-related factors most strongly associated with mortality included an Elixhauser Comorbidity Index score of 20 or higher (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.96-6.60) and care designations excluding admission to the intensive care unit and cardiopulmonary resuscitation (OR 3.52, 95% CI 2.25-5.52). The strongest surgical predictors included neurosurgical admission (OR 2.09, 95% CI 1.17-3.75), emergent surgery (OR 2.04, 95% CI 1.37-3.03) and occurrence of 2 or more operations (OR 1.73, 95% CI 1.21-2.46). Among RRT factors, occurrence of 2 or more RRT assessments (OR 2.01, 95% CI 1.44-2.80) conferred the highest mortality. Increased cost was strongly associated with admitting service, multiple surgeries, multiple RRT assessments and medical comorbidity. RRT activation among surgical inpatients identifies a population at high risk of death. We identified several predictors of mortality and cost, which represent opportunities for future quality improvement and patient safety initiatives.

PROGNOSTIC VALUE OF NEUTROPHIL TO LYMPHOCYTE RATIO IN RAPID RESPONSE TEAM ACTIVATIONS AND MORTALITY

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Neutrophil to lymphocyte ratio (NLR) publications have tripled in the past 5 years reaching over 5,289 in Pubmed as of 5/31/2020. Multiple specialties have studied NLRs as a prognosticating factor as well as its association with mortality. A NLR elevation above 3 is suspected to correlate with increased physiologic stress, but is not universally agreed upon. The aim of our study was to analyze the prognostic value of NLR elevations in Rapid Response Team (RRT) activation times and mortality. Several secondary goals include analyzing previously mentioned questions between NLR and Systemic Inflammatory Response Syndrome (SIRS) while controlling for age, blood pressure, temperature, and pulse rate. METHODS: We retrospectively analyzed all patients who had an RRT in the hospital over a 4 month period (n:89). All RRT patients were included in order to study all causes of “physiologic stress.” NLR was calculated by dividing neutrophils by lymphocytes both at admission and again at the time of RRT. Other data points obtained were age, date/time, vitals, as well as the number of SIRS criteria both at the time of admission and RRT. Survival to discharge was also documented. RESULTS: Using a two sample t-test, a NLR of 3 and above at admission resulted in RRT activation 25 hours sooner when compared to a NLR less than 3 (p-value 0.226). The mean NLR at admission of the deceased vs survivors was 11.6 vs 6.77 (p-value 0.106), whereas the mean NLR at time of RRT of the deceased vs survivors was 14.2 vs 8.8 (p-value 0.009). From our t-test analysis, we can say with 95% confidence, a lower systolic blood pressure and higher pulse at admission positively correlated with death. The predicted odds of a person dying increased by a factor of 1.044 for every one unit increase in NLR at admission. CONCLUSIONS: In our study, patients admitted with a NLR above 3 had their RRT activations a day (25 hours) sooner than those with a NLR of less than 3. Monitoring NLR trends to predict an impending all cause stress event such as a RRT, may be useful as trends were not obtained in our study. NLR may add increased sensitivity and specificity to in-hospital warning systems such as “eCART” and “NEWS”. SIRS criteria positively correlated with an elevated NLR, further pointing towards its potential use as a stress biomarker. A mean NLR of 14 at RRT was associated with mortality. CLINICAL IMPLICATIONS: If these results are further validated, NLR could be an important, simple, and “cheap” option to further risk stratify your hospitalized patients. DISCLOSURES: No relevant relationships by Nicholas Barreras, source=Web Response

I-PASS Illness Severity Identifies Patients at Risk for Overnight Clinical Deterioration.

The I-PASS framework is increasingly being adopted for patient handoffs after a recent study reported a decrease in medical errors and preventable adverse events. A key component of the I-PASS handoff included assignment of illness severity. We evaluated whether illness severity categories can identify patients at higher risk of overnight clinical deterioration as defined by activation of the rapid response team (RRT). The I-PASS handoff documentation created by internal medicine residents and patient charts with overnight RRT activations from April 2016 through March 2017 were reviewed retrospectively. The RRT activations, illness severity categories, vital signs prior to resident handoff, and patient outcomes were evaluated. Of the 28 235 written patient handoffs reviewed, 1.3% were categorized as star (sickest patients at risk for higher level of care), 18.8% as watcher (unsure of illness trajectory), and 79.9% as stable (improving clinical status). Of the 98 RRT activations meeting the inclusion criteria, 5.1% were labeled as star, 35.7% as watcher, and 59.2% as stable. Patients listed as watcher had an odds ratio of 2.6 (95% confidence interval 1.7-3.9), and patients listed as star had an odds ratio of 5.2 (95% confidence interval 2.1-13.1) of an overnight RRT activation compared with patients listed as stable. The overall in-hospital mortality of patients with an overnight RRT was 29.6%. The illness severity component of the I-PASS handoff can identify patients at higher risk of overnight clinical deterioration and has the potential to help the overnight residents prioritize patient care.

IMPACT OF HOSPITAL-WIDE EDUCATION PROGRAMS ON THE RAPID RESPONSE TEAM ACTIVATION RATE AND INCIDENCE OF CARDIAC ARREST IN A COMMUNITY TEACHING HOSPITAL

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To evaluate the impact of hospital wide education programs and re-education of staff on rapid response team activation rate and cardiac arrest in a hospital with an established rapid response team. METHODS: Retrospective analysis of perspective and collective data between January 2018 and December 2019. The education program includes sixty minute lectures to educate nursing staff on the description of established rapid response team, which includes activation criteria, early manifestation of decompensating patients and the roles of rapid response team members. Addressing different culture changes that may hinder or compromise the activation process and re-emphasize the early identification of the critically ill patient. The education took place between October 1st, 2018 and December 30th ,2018. RESULTS: The number of codes per 1000 discharge days declined from almost 10 in 2018 to 8 in the months following the hospital wide re-education initiative. The percentage of inpatient discharges on whom rapid response team was called increased by more than 2 % following the initiative. To prove statistical significance we used the Pearson’s Correlation Coefficient (r) to analyze the relationship between rapid response teams calls and the number of codes that were called. CONCLUSIONS: This decrease in the percentages of codes correlates with more rapid response team calls and early identification of critically ill patients therefore transferring patients to a higher level of care earlier and involving the intensive care team at an earlier stage of their disease process. The data suggests that the education program had a gradual effect, as the percentage of inpatient discharges on whom rapid response teams were called increased steadily in the following months. . This data trend is consistent with similar studies that show that the maximal effects of intervention (education programs) continue to be effective several months after its implementation. CLINICAL IMPLICATIONS: Hospitals would benefit from continued educational programs to remind staff about the role of rapid response teams, address barriers to calling and involving the critical care team and early identification of the decompensating patient. This translates into better patient outcomes with reduction in codes called on inpatients. DISCLOSURES: No relevant relationships by Chadi Bouserhal, source=Web Response No relevant relationships by Nidal Boutros, source=Web Response No relevant relationships by Ivor O'Connor, source=Web Response

EFFECTIVENESS OF TOPIC-DIRECTED EDUCATION ON INTERNAL MEDICINE RESIDENTS’ CONFIDENCE IN RAPID RESPONSES

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: A rapid response is an acute change in the clinical status of a hospital patient requiring rapid attention. The Rapid Response Team (RRT) is an integral part of Mercy Hospital’s ability to deliver excellent quality of care. The RRT at our hospital consists of internal medicine (IM) residents, intensive care unit and floor registered nurses, and a respiratory therapist. There is no standard method for running RRTs and there exists limited research on the practice. There is question whether new and current residents are prepared to work together confidently and effectively in these acute events. The purpose of our study is to determine whether delivering a multidisciplinary educational series alone will improve our residents’ confidence and effectiveness in conducting a rapid response. METHODS: A retrospective chart review was performed on 89 patients over 4 months which revealed the most common RRT activations to be altered mental status, shortness of breath, seizures, tachyarrhythmia’s, stroke like symptoms and chest pain. Residents were surveyed using the Lichen Score for Confidence Scale by both pre- and post-education intervention. Each survey consisted of 10 questions. Our intervention consisted of a multidisciplinary team of hospitalists, intensivists, cardiologists, neurologists and pulmonologists who created a focused lecture. A 3-hr data-driven lecture was given to residents in groups of 12 while maintaining a high ratio of specialist to resident. Eventually all 60 residents underwent the intervention over the course of 5 weeks. RESULTS: Analyzing the questions separately, Levene’s Test for Equality of Variance showed: “Running a RRT right now” (P value= 0.017), “Initiating a code stroke and being comfortable administering tPA” (P value= 0.006) and “Hypotension” (P value= 0.0027). The analysis across all 10 questions resulted in an average increased confidence (p-value: 0.0028). CONCLUSIONS: In our study at Mercy Hospital, Residents’ confidence in responding to many of the most common rapid responses improved by statistical significance. This was achieved with our data-driven, multidisciplinary lecture intervention that was only 3 hours in length. Most notably, the improvement of confidence was shown across all 10 questions with only a brief intervention. CLINICAL IMPLICATIONS: The minimal lecture time with high specialist to resident trainee ratio can be used to significantly improve a resident’s confidence in responding to the most common rapid response types within a given hospital. The next step would be to determine if this improves patient outcomes and dispositions. DISCLOSURES: No relevant relationships by Nicholas Barreras, source=Web Response No relevant relationships by Christopher Bowman, source=Web Response