Unplanned ICU Admission From Hospital Wards After Rapid Response Team Review in Australia and New Zealand

Orosz, Judit; Bailey, Michael; Udy, Andrew; Pilcher, David; Bellomo, Rinaldo; Jones, Daryl

doi:10.1097/ccm.0000000000004353

Cited by 20 publications

(28 citation statements)

References 30 publications

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“…Covariates considered as potential confounders of hospital outcomes based on previous studies were extracted from the KSA database [ 8 , 24 , 25 ]. These variables included demographic factors such as age, sex, and body mass index (BMI), comorbidities, suspected infection site, blood culture positivity, including multidrug-resistant (MDR) pathogens, and measures of illness severity, such as the presence of septic shock, serum lactate level, or the sequential organ failure assessment score (SOFA).…”

Section: Methodsmentioning

confidence: 99%

Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

et al. 2022

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Background Hospital-onset sepsis is associated with a higher in-hospital mortality rate than community-onset sepsis. Many hospitals have implemented rapid response teams (RRTs) for early detection and timely management of at-risk hospitalized patients. However, the effectiveness of an all-day RRT over a non-all-day RRT in reducing the risk of in-hospital mortality in patient with hospital-onset sepsis is unclear. We aimed to determine the effect of the RRT’s operating hours on in-hospital mortality in inpatient patients with sepsis. Methods We conducted a nationwide cohort study of adult patients with hospital-onset sepsis prospectively collected from the Korean Sepsis Alliance (KSA) Database from 16 tertiary referral or university-affiliated hospitals in South Korea between September of 2019 and February of 2020. RRT was implemented in 11 hospitals, of which 5 (45.5%) operated 24-h RRT (all-day RRT) and the remaining 6 (54.5%) had part-day RRT (non-all-day RRT). The primary outcome was in-hospital mortality between the two groups. Results Of the 405 patients with hospital-onset sepsis, 206 (50.9%) were admitted to hospitals operating all-day RRT, whereas 199 (49.1%) were hospitalized in hospitals with non-all-day RRT. A total of 73 of the 206 patients in the all-day group (35.4%) and 85 of the 199 patients in the non-all-day group (42.7%) died in the hospital ( P = 0.133). After adjustments for co-variables, the implementation of all-day RRT was associated with a significant reduction in in-hospital mortality (adjusted odds ratio 0.57; 95% confidence interval 0.35–0.93; P = 0.024). Conclusions In comparison with non-all-day RRTs, the availability of all-day RRTs was associated with reduced in-hospital mortality among patients with hospital-onset sepsis. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04149-z.

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Section: Methodsmentioning

confidence: 99%

Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

et al. 2022

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“…Ten studies identified respiratory symptoms, specifically tachypnea at >25 breaths per minute and oxygen saturation at <90%, as the top triggers for RRT activation (Byrne et al, 2021;Churpek et al, 2017;Considine et al, 2017;Currey et al, 2022;Fernando et al, 2019;Lyons et al, 2019;Sebat et al, 2020;Shappell et al, 2018;Tirkkonen et al, 2017;Viana et al, 2021). The RRT was also activated for new-onset breathing difficulty, bradypnea, acute respiratory distress, chronic respiratory disease, and complex respiratory failure (Byrne et al, 2021;Fernando et al, 2019;Lyons et al, 2019;Na et al, 2020;Orosz et al, 2020;Shappell et al, 2018;Smith et al, 2017;Tirkkonen et al, 2017;Viana et al, 2021). Cardiovascular was the second most common activation category, with six studies identifying these issues as the top concern for RRT activation (Kim et al, 2021;Na et al, 2020;Padilla & Mayo, 2019;Sebat et al, 2020;Shoaib et al, 2021;Smith et al, 2017).…”

Section: Adult Triggersmentioning

confidence: 99%

Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review

Ali

Amir

Punjwani

et al. 2023

Rehabilitation Nursing

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PurposeThis integrative review aims to identify the triggers for rapid response team (RRT) activation and their outcomes in pediatric patients and to compare them with those of adult patients. In addition, this integrative review synthesizes the outcomes of cardiopulmonary resuscitation (CPR), intensive care unit (ICU) admission, length of hospital stay, and mortality following RRT activation.MethodAn integrative review using the Whittemore and Knafl methodology was undertaken with a search of three large databases (PubMed, Ovid MEDLINE, and CINAHL) and found 25 relevant studies published in the years 2017 through 2022.ResultsTachypnea, decreased oxygen saturation, tachycardia, changes in blood pressure, and level of consciousness were the most common triggers in both populations. However, specific activation triggers differed between children and adults.ConclusionsThe most common triggers for RRT are detectable through vital signs monitoring; therefore, vigilant tracking of patients’ vital signs is critical and can provide early clues to clinical deterioration.

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“…Overall ICU and hospital mortality rates were 12.3% (51/413) and 13.6% (56/411) respectively, with no significant difference between the groups. Even though the ICU length of stay was similar between the two groups (median, 6 days; IQR, 3-16 days), patients in the RRT review group had a longer hospital length of stay (median, 18 [IQR, 11-33] v 13 days [IQR, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]; P < 0.001). The hospital readmission rate was 16.2%, which was similar between the groups (Table 3).…”

Section: Outcome Data Based On Prior Rrt Reviewmentioning

confidence: 99%

Intensive care admissions following rapid response team reviews in patients with COVID-19 in Australia

Johnston¹,

Subramaniam²,

Orosz³

et al. 2022

Critical Care and Resuscitation

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OBJECTIVES: To evaluate the epidemiology of rapid response team (RRT) reviews that led to intensive care unit (ICU) admissions, and to evaluate the frequency of in-hospital cardiac arrests (IHCAs) among ICU patients with confirmed coronavirus disease 2019 (COVID-19) in Australia. DESIGN: Multicentre, retrospective cohort study. SETTING: 48 public and private ICUs in Australia. . PARTICIPANTS: All adults (aged ≥ 16 years) with confirmed COVID-19 admitted to participating ICUs between 25 January and 31 October 2020, as part of SPRINT-SARI (Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection) Australia, which were linked with ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD). MAIN OUTCOME MEASURES AND RESULTS: Of the 413 critically ill patients with COVID-19 who were analysed, 48.2% (199/413) were admitted from the ward and 30.5% (126/413) were admitted to the ICU following an RRT review. Patients admitted following an RRT review had higher Acute Physiology and Chronic Health Evaluation (APACHE) scores, fewer days from symptom onset to hospitalisation (median, 5.4 [interquartile range (IQR), 3.2–7.6] v 7.1 days [IQR, 4.1–9.8]; P < 0.001) and longer hospitalisations (median, 18 [IQR, 11–33] v 13 days [IQR, 7–24]; P < 0.001) compared with those not admitted via an RRT review. Admissions following RRT review comprised 60.3% (120/199) of all ward-based admissions. Overall, IHCA occurred in 1.9% (8/413) of ICU patients with COVID-19, and most IHCAs (6/8, 75%) occurred during ICU admission. There were no differences in IHCA rates or in ICU or hospital mortality rates based on whether a patient had a prior RRT review or not. CONCLUSIONS: This study found that RRT reviews were a common way for deteriorating ward patients with COVID-19 to be admitted to the ICU, and that IHCA was rare among ICU patients with COVID-19.

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Unplanned ICU Admission From Hospital Wards After Rapid Response Team Review in Australia and New Zealand

Cited by 20 publications

References 30 publications

Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review

Intensive care admissions following rapid response team reviews in patients with COVID-19 in Australia

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