Characteristics of Rapid Response Calls in the United States: An Analysis of the First 402,023 Adult Cases From the Get With the Guidelines Resuscitation-Medical Emergency Team Registry

Abstract

Objectives: To characterize the rapid response team activations, and the patients receiving them, in the American Heart Association-sponsored Get With The Guidelines Resuscitation-Medical Emergency Team cohort between 2005 and 2015. Design: Retrospective multicenter cohort study. Setting: Three hundred sixty U.S. hospitals. Patients: Consecutive adult patients experiencing rapid response team activation. Interventions: Rapid response team activation. Measurements and Main Results: The cohort included 402,023 rapid response team activations from 347,401 unique healthcare encounters. Respiratory triggers (38.0%) and cardiac triggers (37.4%) were most common. The most frequent interventions—pulse oximetry (66.5%), other monitoring (59.6%), and supplemental oxygen (62.0%)—were noninvasive. Fluids were the most common medication ordered (19.3%), but new antibiotic orders were rare (1.2%). More than 10% of rapid response teams resulted in code status changes. Hospital mortality was over 14% and increased with subsequent rapid response activations. Conclusions: Although patients requiring rapid response team activation have high inpatient mortality, most rapid response team activations involve relatively few interventions, which may limit these teams’ ability to improve patient outcomes.

A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea

“…Among the subjects in this study, 70.4% had been hospitalized in the medical department, which was a result similar to that reported in previous studies [ 11 , 15 ], but the proportions of subjects with solid cancer and hematological malignancy were high, at 39% and 9.5%, respectively, accounting for approximately half of all subjects (47.9%). However, the proportion of subjects with DNR discussion was 10.6%, and the ICU transfer rate was 29.5%, which were not higher than those reported in other studies [ 16 , 17 ].…”

“…However, the cohort in this study shows higher intervention rates when comparing by item. In the large-scale study by Lyons et al that included 151,400 cases of RRT activation in major hospitals in the United States, the rate for intubation was 4.6% (vs. 13.3% in the cohort of this study), bedside ultrasonography was 0.3% (vs. 13% in the cohort of this study), and newly started antibiotics was 1.5% (vs. 6.6% in the cohort of this study), which were lower than those in this study [ 11 ]. In the study by Chan et al published in 2008, the rate of intubation was 7.4% (vs. 13.3% in the cohort of this study), arterial line insertion was 0.8% (vs. 17.9% in the cohort of this study), and intravenous vasopressor administration was 1.3% (vs. 12.9% in the cohort of this study), which showed lower intervention rates than those reported in this study [ 12 ].…”

<p>Perioperative Medical Emergencies in a 23-Hour Surgical Procedure Unit</p>

“…Hospitalwide medical emergency triggers based on USA data include cardiovascular 37.4%, respiratory 38%, neurological 30.7%. 8 The standard day procedure working hours at our institution are 08:00 to 17:00. Nine MER call and three CB events occurred outside of standard day procedure working hours, representing 25.5% of MER/CB events in the unit, and 1.63% of all events in the hospital.…”

“…System activations from staff members who are concerned or 'worried' about the patient account for 14-25% of activations. 8,11 Post-operative hypotension was the single most common RDR parameter (n=16). With the exception of the case involving a septoplasty and turbinate reduction, all other cases were managed on the ward with intravenous fluids ± further investigations such as bloods and ECG without transfer.…”

“…13 A US-based retrospective audit for a general hospital including all medical and surgical wards showed a transfer rate of 30% to ICU and 7.4% to a dedicated monitored bed. 8 The importance of the availability of HDU facilities is emphasized by a UK-based retrospective audit that showed post-operative surgical patients who require HDU, but are admitted to the general surgical ward tend to receive inadequate nursing intervention and monitoring. 14 Our data provides an illustration of the medical emergencies that occur in a 23 hour surgery unit.…”