Outcomes of Older Hospitalized Patients Requiring Rapid Response Team Activation for Acute Deterioration
- 1 December 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 46 (12), 1953-1960
- https://doi.org/10.1097/ccm.0000000000003442
Abstract
Rapid response teams are groups of healthcare providers that have been implemented by many hospitals to respond to acutely deteriorating patients admitted to the hospital wards. Hospitalized older patients are at particular risk of deterioration. We sought to examine outcomes of older patients requiring rapid response team activation. Analysis of a prospectively collected registry. Two hospitals within a single tertiary care level hospital system between 2012 and 2016. Five-thousand nine-hundred ninety-five patients were analyzed. Comparisons were made between older patients (defined as ≥ 75 yr old) and younger patients. None. All patient information, outcomes, and rapid response team activation information were gathered at the time of rapid response team activation and assessment. The primary outcome was in-hospital mortality, analyzed using multivariate logistic regression. Two-thousand three-hundred nine were older patients (38.5%). Of these, 835 (36.2%) died in-hospital, compared with 998 younger patients (27.1%) (adjusted odds ratio, 1.83 [1.54–2.18]; p < 0.001). Among patients admitted from home, surviving older patients were more likely to be discharged to a long-term care facility (adjusted odds ratio, 2.38 [95% CI, 1.89–3.33]; p < 0.001). Older patients were more likely to have prolonged delay to rapid response team activation (adjusted odds ratio, 1.79 [1.59–2.94]; p < 0.001). Among patients with goals of care allowing for ICU admission, older patients were less likely to be admitted to the ICU (adjusted odds ratio, 0.66 [0.36–0.79]), and less likely to have rapid response team activation during daytime hours (adjusted odds ratio, 0.73 [0.62–0.98]; p < 0.001). Older patients with in-hospital deterioration requiring rapid response team activation had increased odds of death and long-term care disposition. Rapid response team activation for older patients was more likely to be delayed, and occur during nighttime hours. These findings highlight the worse outcomes seen among older patients with in-hospital deterioration, identifying areas for future quality improvement.This publication has 43 references indexed in Scilit:
- Effect of rapid response systems on hospital mortality: a systematic review and meta-analysisIntensive Care Medicine, 2016
- Rapid response systems: a systematic review and meta-analysisCritical Care, 2015
- What’s new with rapid response systems?Intensive Care Medicine, 2014
- Rapid-Response Systems as a Patient Safety StrategyAnnals of Internal Medicine, 2013
- Rapid-Response TeamsThe New England Journal of Medicine, 2011
- Rapid Response TeamsArchives of Internal Medicine, 2010
- Findings of the First Consensus Conference on Medical Emergency Teams*Critical Care Medicine, 2006
- Long term effect of a medical emergency team on cardiac arrests in a teaching hospitalCritical Care, 2005
- A comparison of Antecedents to Cardiac Arrests, Deaths and EMergency Intensive care Admissions in Australia and New Zealand, and the United Kingdom—the ACADEMIA studyResuscitation, 2004
- Medical patients at high risk for catastrophic deteriorationCritical Care Medicine, 1987