The Effect of Rapid Response Teams on End‐of‐Life Care: A Retrospective Chart Review

Tam, Benjamin; Salib, Mary; Fox‐Robichaud, Alison

doi:10.1155/2014/393807

Cited by 21 publications

(16 citation statements)

References 34 publications

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“…That study analyzed 77 critically ill patients with cancer who were managed on the ward and demonstrated that patients who were managed jointly with a rapid response team had a survival rate of 68% compared with 60% for those who were treated by the primary oncologic team only. An additional benefit of rapid response teams could be that they can initiate discussions about appropriate treatment goals and thus reduce inappropriate ICU admissions …”

Section: Interdisciplinary Care For Critically Ill Patients With Cancermentioning

confidence: 99%

“…An additional benefit of rapid response teams could be that they can initiate discussions about appropriate treatment goals and thus reduce inappropriate ICU admissions. [45][46][47] Unfortunately, there are still substantial organizational and cultural barriers that prevent more effective multidisciplinary care for critically ill patients with cancer. The degree of interdisciplinarity necessary for the care of this patient population can also serve as a source of conflict and requires a mutual understanding of differences in perspective.…”

Section: Interdisciplinary Care For Critically Ill Patients With Cancermentioning

confidence: 99%

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Critical care of patients with cancer

Shimabukuro‐Vornhagen

Böll

Kochanek

et al. 2016

CA A Cancer J Clinicians

115

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Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state-of-the-art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016. © 2016 American Cancer Society.

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Section: Interdisciplinary Care For Critically Ill Patients With Cancermentioning

confidence: 99%

Section: Interdisciplinary Care For Critically Ill Patients With Cancermentioning

confidence: 99%

Critical care of patients with cancer

Shimabukuro‐Vornhagen

Böll

Kochanek

et al. 2016

CA A Cancer J Clinicians

115

View full text Add to dashboard Cite

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“…In one study, patients whose end of life status changed as a result of a RRT had more than 50% decrease in transfers to ICU (8.4% vs 17%) and a tripling in palliative care referrals (25% vs 8%). 31 In a systematic review of 16 studies, limitations of medical therapy were instituted in between 2% and 31% of RRT calls. 32 However, such benefits were not seen in every study, 33 up to 15% of RRT calls are activated despite DNR orders, 34 and many patients undergoing calls should have been classified as in need of palliative care well before such calls were activated.…”

Section: Benefits Of Rrtmentioning

confidence: 99%

“…Facilitating a more dignified death with less aggressive intervention and earlier access to palliative care in itself may be regarded as a ‘benefit’ of RRT systems. In one study, patients whose end of life status changed as a result of a RRT had more than 50% decrease in transfers to ICU (8.4% vs 17%) and a tripling in palliative care referrals (25% vs 8%) . In a systematic review of 16 studies, limitations of medical therapy were instituted in between 2% and 31% of RRT calls .…”

Section: Introductionmentioning

confidence: 99%

Rapid response teams in adult hospitals: time for another look?

White

Scott

Vaux

et al. 2015

Internal Medicine Journal

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Rapid response teams (RRT), alternatively termed medical emergency teams, have become part of the clinical landscape in the majority of adult hospitals throughout Australia and New Zealand. These teams aim to bring critical care expertise to the bedside of clinically deteriorating patients residing in general hospital wards with the aim of preventing adverse outcomes, in particular death or cardiorespiratory arrests. While the concept of RRT has considerable face validity, there is little high quality evidence of their effectiveness and much uncertainty as to the optimal methods for identifying patients in need of RRT and calling the RRT (afferent limb) and how, and with whom, the RRT should then respond (efferent limb). Adverse unintended consequences of RRT systems and the opportunity costs involved in maintaining such systems have not been subject to study, amid concerns RRT may be compensating for other potentially remediable system of care failures. This article presents an overview of the current state of play of RRT in hospital practice as they pertain to the care of adult patients and identifies several issues around their implementation and evaluation that should be subject to further research.

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“…Critical Care Rapid Response Teams have increasingly been called on to facilitate discussions of non-offers of LST, including CPR. 13,14 Since the CCRT and ICU teams provide LST, they are ideally best suited to discuss whether such treatments have any potential to help patients, particularly those near the EOL. Given the sheer volume of work involved and the amount of time required, it would be prohibitive for these teams to initiate proper discussions with all patients in the hospital.…”

Section: Understand the Implications For Perioperative And Periprocedmentioning

confidence: 99%

“Must do CPR??”: strategies to cope with the new College of Physicians and Surgeons of Ontario policy on end-of-life care

Hawryluck

Oczkowski

Handelman³

2016

Can J Anesth/J Can Anesth

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The College of Physicians and Surgeons of Ontario recently released a new policy, Planning for and Providing Quality End-of-Life Care. The revised policy is more accurate in its consideration of the legal framework in which physicians practice and more reflective of ethical issues that arise in end-of-life (EOL) care. It also recognizes valid instances for not offering cardiopulmonary resuscitation (CPR). Nevertheless, the policy poses a significant ethical and legal dilemma-i.e., if disputes over EOL care arise, then physicians must provide CPR even when resuscitation would fall outside this medical standard of care. While the policy applies in Ontario, it is likely to influence other physician colleges across Canada as they review their standards of practice. This paper explores the rationale for the mandated CPR, clarifies the policy's impact on the medical standard of care, and discusses strategies to improve EOL care within the policy. These strategies include understanding the helphurt line, changing the language used when discussing cardiac arrest, clarifying care plans during the perioperative period, engaging the intensive care unit team early in goals-of-care discussions, mentoring hospital staff to improve skills in goals-of-care discussions, avoiding use of the ''slow code'', and continuing to advocate for quality EOL care and a more responsive legal adjudication process.Résumé L'Ordre des médecins et chirurgiens de l'Ontario a récemment publié une nouvelle politique, Planifier et prodiguer des soins de fin de vie de qualité. La politique révisée est plus précise dans sa considération du cadre légal dans lequel pratiquent les médecins et reflète mieux les questions déontologiques qui surgissent en matière de soins de fin de vie. Elle reconnaît également des exemples valables dans lesquels il ne faut pas offrir de réanimation cardiorespiratoire (RCR). Toutefois, la politique pose un dilemme éthique et légal de taille : si des disputes concernant les soins de fin de vie surviennent, alors les médecins doivent fournir une RCR même lorsque la réanimation tomberait en dehors de cette norme de soins médicale. Bien que la politique ne s'applique qu'en Ontario, il est probable qu'elle aura un impact sur d'autres collèges de médecins au pays lorsqu'ils réviseront leurs normes de pratique. Cet article explore la justification d'une RCR obligatoire, clarifie l'impact de la politique sur la norme de soins médicale, et examine différentes stratégies pour améliorer les soins de fin de vie dans le cadre de la politique. Voici quelques-unes de ces stratégies: une compréhension de la ligne entre aider et blesser, la modification de la terminologie utilisée lorsqu'on parle d'arrêt cardiaque, la clarification des plans de soins pendant la période périopératoire, l'implication rapide de l'équipe de l'unité des soins intensifs dans les discussions concernant les objectifs de soins, la formation du personnel hospitalier afin d'améliorer ses compétences dans les discussions concernant les objectifs de soins, le fa...

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The Effect of Rapid Response Teams on End‐of‐Life Care: A Retrospective Chart Review

Abstract: A change in EOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions.

Cited by 21 publications

References 34 publications

Critical care of patients with cancer

Critical care of patients with cancer

Rapid response teams in adult hospitals: time for another look?

“Must do CPR??”: strategies to cope with the new College of Physicians and Surgeons of Ontario policy on end-of-life care

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