Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study

<jats:sec><jats:title>Background</jats:title><jats:p>The characteristics of mature contemporary rapid response systems are unclear.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To determine the patient characteristics, processes and outcomes, both in‐hospital and post‐discharge, of a well‐established rapid response system in a tertiary adult hospital.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a prospective study of consecutive rapid response team (<jats:styled-content style="fixed-case">RRT</jats:styled-content>) activations between 1 July and 25 November 2015. Variables included patient characteristics, timing, location and triggers of <jats:styled-content style="fixed-case">RRT</jats:styled-content> activations, interventions undertaken, mortality and readmission status at 28 days post‐discharge.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 1151 <jats:styled-content style="fixed-case">RRT</jats:styled-content> activations was analysed (69.1 per 1000 admissions), involving 800 patients, of whom 81.5% were emergency admissions. A total of 351 (30.5%) activations comprised repeat activations for the same patient. Most activations (723; 62.8%) occurred out of hours, and 495 (43%) occurred within 48 h of admission. Hypotension, decreased level of consciousness and oxygen desaturation were the most common triggers. Advanced life support was undertaken in less than 7%; 198 (17.2%) responses led to transfer to higher‐level care units. Acute resuscitation plans were noted for only 29.1% of <jats:styled-content style="fixed-case">RRT</jats:styled-content> activations, with 80.3% stipulating supportive care only. A total of 103 (12.6%) patients died in hospital, equalling 14 deaths per 100 <jats:styled-content style="fixed-case">RRT</jats:styled-content> activations. At 28 days, 150 (18.8%) patients had died, significantly more among those with multiple versus single <jats:styled-content style="fixed-case">RRT</jats:styled-content> activations (24.9 vs 16.6%; odds ratio 1.66, 95% confidence interval 1.31–2.44; <jats:italic>P</jats:italic> = 0.013).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Relatively few <jats:styled-content style="fixed-case">RRT</jats:styled-content> activations are associated with acute resuscitation plans, and most interventions during <jats:styled-content style="fixed-case">RRT</jats:styled-content> responses are low level. The high rate of post‐<jats:styled-content style="fixed-case">RRT</jats:styled-content> deaths and transfers to higher‐level care units calls for the prospective identification of such patients in targeting appropriate care.</jats:p></jats:sec>