Rapid response team calls to patients with a pre-existing not for resuscitation order

Epidemiology of in‐hospital mortality in acute patients admitted to a tertiary‐level hospital

“…Among the patients who received a MET call, 26% had a NFR, and approximately 52% of these patients died while in hospital. These figures are comparable with other research conducted in this area . It is therefore important to re‐iterate to hospital staff that the institution of a NFR order should not be equated with ceasing active treatment measures but rather a confirmation that deterioration and death would not be unexpected and that further escalation above ward‐based care would be unlikely to reverse this.…”

“…These figures are comparable with other research conducted in this area. 12,19 It is therefore important to re-iterate to hospital staff that the institution of a NFR order should not be equated with ceasing active treatment measures but rather a confirmation that deterioration and death would not be unexpected and that further escalation above ward-based care would be unlikely to reverse this. This is an important distinction for doctors, patients and their families to understand as some may equate NFR with abandonment or failure.…”

Failure to activate the in-hospital emergency team: causes and outcomes

“…The MET is not activated in 30 to 78% patients with MET activation criteria; even when activation occurs, there is an average delay of 16 hours. (9-13) This afferent limb failure (ALF) has a negative impact on prognosis (14) and results in obvious expenses for the health system.…”

Integration of Palliative Care in the Context of Rapid Response

“…RRTs are oft en involved in the care of patients for whom an order limiting life support was already documented. 39 At least one member of the team should have responsibility to review the medical record for such documentation, consider the applicability of any advance directive, and contact the primary clinician/service, if possible, for verifi cation. If an intervention is indicated and the patient is able and willing to make decisions about treatment, it is appropriate to discuss the intervention with the patient in the context of the current clinical situation and previously documented preferences that might now be revisited if time and circumstances permit.…”