Rapid Response Teams (RRT) were created with the concept of bringing intensive care management to the bedside during medical emergencies on the wards. Despite widespread use, their overall benefit has been controversial. Although some studies have shown reduction in cardiac arrest outside of the intensive care units, overall hospital mortality has not improved. Although some patients may not exhibit signs or symptoms prior to clinical deterioration, failure to recognize or act on early warning signs may have an impact on morbidity and mortality. Focusing on the time frame prior to patient deterioration may identify factors that can be focused on for improved outcomes.
We evaluated all RRT and codes called on the general medical and surgical wards over a 3month period of time. Data was gathered retrospectively via chart and computer review immediately after event to determine factors leading to patient deterioration. A tool was created to review several key elements of patient data including vital signs 8 h prior to event, abnormal laboratories, abnormal imaging, as well as nursing and physician documentation. The obtained data was ultimately classified into three main categories: failure of recognition, failure of communication, and failure of action.
A total of 69 charts were reviewed. From those, 60 were rapid responses, and nine were medical codes. 41% of rapid response or codes showed no early warning signs or changes in clinical status in the 8 h prior to the event, versus 59% that presented with one or more changes. 42% of patients exhibited changes in either laboratories or imaging, of which, 27% were abnormal laboratories. In 65% of cases, there was a delay or failure in communication between staff members. In 38% of cases, there was problem with recognition of clinical deterioration or identification of laboratories abnormalities, and in 20% of cases treatment was delayed.
Although Rapid Response Teams have shown limited impact on overall mortality, there are several factors that have been identified leading up to event that may be intervened on to prevent events all together. Focusing on systems based interventions that address recognition and intervention on physiologic and clinical abnormalities, as well as communication gaps, may improve patient outcomes.
To cite this abstract:Rizk D, Cruz E, Acquah S. Identifying Predictors Leading to Rapid Response or Medical Code. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97571. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/identifying-predictors-leading-to-rapid-response-or-medical-code/. Accessed May 26, 2019.