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To prevent serious adverse events on hospitalized patients, a rapid response team (RRT) was introduced at our institution. This team is comprised of a physician, critical care nurse and respiratory therapist. 7am-7pm Monday to Friday the physician is a critical care attending and fellow (CCAF). 7pm-7am Monday to Friday and 7am Saturday -7am Monday the physician is an internal medicine hospitalist and senior medical resident (IMHR). We sought to analyze this system for consistencies between IMHR run RRT and CCAF run RRT. METHODS:Rapid responses (RR) completed from 1/1/09-12/31/09 were reviewed. After excluding cases with incomplete data, RR were arranged as those run by CCAF RRT and IMHR RRT. Endpoints evaluated were reason for RR, patients requiring multiple RR, final outcome of RR and final outcome of admission.RESULTS: 1031 RR were initiated with 878 acceptable for review. 467 RR were run by CCAF and 411 were run by IMHR. Most common reason RR were initiated was respiratory (CCAF:195, IMHR:200) and neurologic (CCAF:114, IMHR:77). CCAF RRT averaged 2.52 minutes to respond and IMHR RRT averaged 2.62 minutes to respond (p=0.23). CCAF RRT averaged 24.50 minutes/RR and IMHR RRT averaged 28.91 minutes/RR (p=0.001).CCAF RRT kept 286 patients (61%) in their room and escalated care in 115 patients (25%) (intensive care unit (ICU):90;19%, telemetry:25;5%). IMHR RRT kept 236 patients (57%) in their room and escalated care in 114 patients (28%) (ICU:98;24%, telemetry:16;4%) (p=0.44).4 patients (0.86%) expired during CCAF RR and 3 patients (0.73%) expired during IMHR RR (p=0.44). 102 patients required repeat RR (CCAF:45;44%, IMHR:57;56%) (p=0.44). 67 of these patients (66%) did not survive to discharge (CCAF:24, IMHR:23).CONCLUSION: CCAF run RRT completed RR faster than IMHR run RRT. RRT run by CCAF is otherwise equivalent to one run by IMHR in regards to time to respond, and outcome of RR and hospital stay.CLINICAL IMPLICATIONS: This analysis suggests that a RRT may be run by an IMHR without differential in outcome compared to a CCAF.

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58 year old male with seasonal asthma and no family history. Presents for evaluation of incidental finding of lung nodule on computed tomography scan (CT scan). His prior work exposure includes a history as mechanic and some asbestos exposure. History of a positive PPD that was not treated. No symptoms. Lifelong non-smoker. He had a CT chest in 2018, which had no parenchymal findings. He presented to ER 7/2019 with abdominal pain and was found new mass in right lower lobe. He was sent for positron emission tomography (PET scan) CT scan, which found a minimally active, 4cm mass in right lower lobe with no adenopathy, no other abnormalities on either PET or CT were found. Patient was sent for right video assisted thoracoscopic surgery (VATS) with wedge resection and partial diaphragm removal. Pathology showed rearrangement involving the SS18 gene region and a diagnosis of biphasic synovial sarcoma was made. Referred to oncology and therapy and treatment is pending. Sarcomas are a rare group of malignant tumors, and make up less than 1% of all adult malignancies and 12% of pediatric malignancies. The overall prognosis is relatively poor. Approximately 80% of sarcomas originate in the soft tissue, and the rest originate in the bone. In nearly all instances, they are thought to arise de novo, and not from a preexisting benign lesion.