The impact of Rapid Response System on delayed emergency team activation patient characteristics and outcomes—A follow-up study

Calzavacca, Paolo; Licari, Elisa; Tee, Augustine; Egi, Moritoki; Downey, Andrew; Quach, Jon; Haase-Fielitz, Anja; Haase, Michael; Bellomo, Rinaldo

doi:10.1016/j.resuscitation.2009.09.026

Cited by 124 publications

(113 citation statements)

References 21 publications

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“…[2][3][4] The role of MET teams in EOL decision making has been explored in very few studies. [3][4][5] Qualitative investigation has revealed the usefulness of CCOT in facilitating timely EOL decisions and LOMTs.…”

Section: Objectivesmentioning

confidence: 99%

“…A relatively new phenomenon has arisen of patients receiving EOL care in the hospital but outside the intensive care unit. 7 In the Australian studies [3][4][5] that have explored this issue, the MET teams studied comprised doctors who could make LOMT decisions. Models of CCOTs and METs differ worldwide, with some METs being mandated in certain states to see all palliative care patients with acute deteriorations in condition (even at EOL, eg, breathlessness triggering on a warning score).…”

mentioning

confidence: 99%

“…These teams have to make explicit exemption orders. 3,5 This approach differs from practice in the United Kingdom, where CCOTs rarely make overriding decisions about patients transferring to an EOL model, but do see EOL patients with reversible intercurrent critical illness (eg, cardiac arrhythmias). Moreover, nurseled teams predominate in the United Kingdom, which limits the prospect of this model developing.…”

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confidence: 99%

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Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making

Pattison

O’Gara

Wigmore

2015

American Journal of Critical Care

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Background Little research has examined the involvement of critical care outreach teams in end-of-life decision making. Objective To establish how much time critical care outreach teams spend with patients who are subsequently subject to limitation of medical treatment and end-of-life decisions and how much influence the teams have on those decisions. Methods A single-center retrospective review, with qualitative analysis, in a large cancer center. Data from all patients referred emergently for critical care outreach from October 2010 to October 2011 who later had limitation of medical treatment or end-of-life care were retrieved. Findings were analyzed by using SPSS 19 and qualitative free-text analysis. Results Of 890 patients referred for critical care outreach from October 2010 to October 2011, 377 were referred as an emergency; 108 of those had limitation of medical treatment and were included in the review. Thirty-five patients (32.4%) died while hospitalized. As a result of outreach intervention and a decision to limit medical treatment, 56 (51.9%) of the 108 patients received a formal end-of-life care plan (including care pathways, referral to palliative care team, hospice). About a fifth (21.5%) of clinical contact time is being spent on patients who subsequently are subject to limitation of medical treatment. Qualitative document analysis showed 5 emerging themes: difficulty of discussions about not attempting cardiopulmonary resuscitation, complexities in coordinating multiple teams, delays in referral and decision making, decision reversals and opaque decision making, and technical versus ethical imperatives. Conclusion A considerable amount of time is being spent on these emergency referrals, and decisions to limit medical treatment are common. The appropriateness of escalation of levels of care is often not questioned until patients become critically or acutely unwell, and outreach teams subsequently intervene.

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Section: Objectivesmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making

Pattison

O’Gara

Wigmore

2015

American Journal of Critical Care

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“…4 MET activations involve a change in code status in approximately 3% to 10% of cases. [5][6][7][8] However, previous studies primarily involved hospitals in Australia, making the results difficult to generalize to other countries. 3,6,7 There may be important cultural differences in patient and clinician attitudes toward end-oflife care among different countries.…”

Section: Resultsmentioning

confidence: 99%

“…9 Our observed rate is similar to the 3% to 10% rate of MET-implemented DNR orders in previous reports worldwide. 3,5,8,12,13 Recent data from the United States suggest that METs initiate a DNR order in 28% of cases. 14 However, most DNR orders in that study were placed in the ICU days to weeks after MET activation, likely accounting for the high DNR rate.…”

Section: Discussionmentioning

confidence: 99%

Resource utilization and end‐of‐life care in a US hospital following medical emergency team‐implemented do not resuscitate orders

Dargin

Mackey

et al. 2014

Journal of Hospital Medicine

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BACKGROUND: Medical emergency teams frequently implement do not resuscitate orders, but little is known about end-of-life care in this population. OBJECTIVE:To examine resource utilization and end-of-life care following medical emergency team-implemented do not resuscitate orders. DESIGN: Retrospective review.SETTING: Single, tertiary care center. PATIENTS:Consecutive adult inpatients requiring a medical emergency team activation over 1 year. MEASUREMENTS:Changes to code status, time spent on medical emergency team activations, frequency of palliative care consultation, discharges with hospice care.

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Incidence and factors associated with newly implemented do‐not‐attempt‐resuscitation orders among deteriorating patients after rapid response system activation: A retrospective observational study using a Japanese multicenter database

Tsuji

Sento

Nakanishi

et al. 2023

Acute Medicine & Surgery

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AimThe rapid response system (RRS) was initially aimed to improve patient outcomes. Recently, some studies have implicated that RRS might facilitate do‐not‐attempt‐resuscitation (DNAR) orders among patients, their families, and healthcare providers. This study aimed to examine the incidence and factors independently associated with DNAR orders newly implemented after RRS activation among deteriorating patients.MethodsThis observational study assessed patients who required RRS activation between 2012 and 2021 in Japan. We investigated patients’ characteristics and the incidence of new DNAR orders after RRS activation. Furthermore, we used multivariable hierarchical logistic regression models to explore independent predictors of new DNAR orders.ResultsWe identified 7904 patients (median age, 72 years; 59% male) who required RRS activation at 29 facilities. Of the 7066 patients without pre‐existing DNAR orders before RRS activation, 394 (5.6%) had new DNAR orders. Multivariable hierarchical logistic regression analyses revealed that new DNAR orders were associated with age category (adjusted odds ratio [aOR], 1.56; 95% confidence interval, 1.12–2.17 [65–74 years old reference to 20–64 years old], aOR, 2.56; 1.92–3.42 [75–89 years old], and aOR, 6.58; 4.17–10.4 [90 years old]), malignancy (aOR, 1.82; 1.42–2.32), postoperative status (aOR, 0.45; 0.30–0.71), and National Early Warning Score 2 (aOR, 1.07; 1.02–1.12 [per 1 score]).ConclusionThe incidence of new DNAR orders was one in 18 patients after RRS activation. The factors associated with new DNAR orders were age, malignancy, postoperative status, and National Early Warning Score 2.

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The impact of Rapid Response System on delayed emergency team activation patient characteristics and outcomes—A follow-up study

Cited by 124 publications

References 21 publications

Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making

Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making

Resource utilization and end‐of‐life care in a US hospital following medical emergency team‐implemented do not resuscitate orders

Incidence and factors associated with newly implemented do‐not‐attempt‐resuscitation orders among deteriorating patients after rapid response system activation: A retrospective observational study using a Japanese multicenter database

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