Utilization Of Rapid Response Resources And Outcomes At A Comprehensive Cancer Center

Austin, Charles; Mayer, Celeste; Stafford, Renae E.; Culp, Loc; Chang, Lydia

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6581

Cited by 5 publications

(11 citation statements)

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“…In this study, the in-hospital mortality rate was significantly higher among cancer patients who required ICU transfer after an RRT event than among non-cancer patients, consistent with previous studies [12,19,20]. Therefore, determination of key prognostic predictors of poor outcome is crucial to identifying patients who may benefit from ICU admission.…”

Section: Discussionsupporting

confidence: 88%

“…Previous studies reported an association between early intervention (i.e., before development of severe organ failure) and better outcomes despite the inherently high acuity level in this population [10,11]. Compared with noncancer patients, cancer patients experienced higher rates of in-hospital mortality after RRT activation [12]. Moreover, as RRTs are often activated during the end-of-life stage, RRT activation might play an important role in discussions regarding goals of care or initiation of palliative care for a cancer patient [12][13][14].…”

Section: Introductionmentioning

confidence: 81%

“…Compared with noncancer patients, cancer patients experienced higher rates of in-hospital mortality after RRT activation [12]. Moreover, as RRTs are often activated during the end-of-life stage, RRT activation might play an important role in discussions regarding goals of care or initiation of palliative care for a cancer patient [12][13][14]. To date, few studies have investigated the utilization and outcomes of RRTs in cancer patients.…”

Section: Introductionmentioning

confidence: 99%

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Utilization of a rapid response team and associated outcomes in patients with malignancy

et al. 2020

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Utilization of a rapid response team and associated outcomes in patients with malignancy Background: Recent advances in diagnosis and treatment have improved long-term outcomes in cancer patients. As a result, the requirement for a rapid response team (RRT) for cancer patients is also increasing. This study aimed to analyze utilization of an RRT and the associations between related factors and mortality in a population of cancer patients. Methods: This retrospective cohort study included hospitalized patients at a single academic medical center in Seoul, Korea, who required RRT activation during a 6-year period from June 2013 to December 2018. Results: Overall, 164 of the 457 patients who met the above criteria were cancer patients, and they had a significantly higher Charlson comorbidity score than the non-cancer patients (5.0 vs. 7.0, P < 0.001). A significantly larger proportion of cancer patients required intensive care unit transfer (51.8% vs. 41.0%, P = 0.032). Cancer patients also had significantly higher in-hospital mortality compared with other patients (39.6% vs. 10.9%, P < 0.001). Furthermore, presence of cancer was independently associated with in-hospital mortality (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.11 to 3.93). Among cancer patients, higher Acute Physiology and Chronic Health Evaluation (APACHE) II at the time of RRT activation was significantly associated with in-hospital mortality regardless of malignancy (adjusted OR, 1.08; 95% CI, 1.01 to 1.15). Conclusions: Cancer patients requiring RRT activation have significantly higher rates of inhospital mortality than patients not using RRT. Higher severity score at the time of RRT activation in patients with malignancy was significantly associated with in-hospital mortality.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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Utilization of a rapid response team and associated outcomes in patients with malignancy

et al. 2020

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“…The inpatient mortality rate after an RRT activation in our study closely resembled the rate reported by Austin and colleagues, which was 33% (hospital mortality in oncology patients cited during the time was 48.2 deaths per 1,000 patient admissions). 17 Of note in our study is that solid tumor patients had higher mortality than the hematologic malignancy patients; 43% died within the same hospital stay and 78% died within 100 days, compared with 35% and 55%, respectively, in patients with hematologic malignancies. The poor prognosis of oncology patients requiring an RRT evaluation must be conveyed to the patients and families and taken into consideration by health care team to determine the most appropriate course of care subsequent to RRT activation.…”

Section: Discussionmentioning

confidence: 52%

“…11,16 RRT activation in the oncology population is of special interest because the activation may predict higher inpatient mortality. 17 In addition, RRT activation can serve as a sentinel event that fosters discussion on goals of care, change in code status, and initiation of palliative care or hospice use, particularly when also accompanied by an upgrade in level of care. 11,18 As such, the ability to predict mortality after an RRT event, both inpatient and at 100 days after the event, could be of great help in deciding whether to pursue further treatments or, alternatively, palliative or hospice care.…”

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confidence: 99%

Mortality outcomes in hospitalized oncology patients after rapid response team activation

Palmisiano¹

2018

JCSO

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Background The prognosis of hospitalized oncology patients varies widely, and physicians are poor at predicting outcomes in cancer patients. Discrete signifiers of prognosis in hospitalized oncology patients are widely sought. Objective To test the hypothesis that oncology patients who have had rapid response team (RRT) activations would have high rates of in-hospital and 100-day mortality, and that these might differ based on malignancy type and other clinical factors. Methods A retrospective study was performed at a single, 900+ bed academic center in the northeastern United States during a 2-year study period using an RRT-specific database. We included patients 18 years or older with a cancer diagnosis, including solid tumor and hematologic malignancy, as well as those who were status post-bone marrow transplantation, who required RRT activation. Surgical and intensive care unit patients were excluded. Primary outcome variables of interest were inpatient and 100day mortality post-RRT activation as well as the clinical variables leading up to RRT activation. Results RRT activation was associated with a high inpatient mortality in patients with solid tumor and hematologic malignancies (43% and 35%, respectively) and a 100-day mortality (solid tumors, 78%; hematologic malignancies, 55%). In multivariate analysis, female sex was associated with significantly higher inpatient and 100-day mortality. Limitations This retrospective review of a single center's data on oncology patients may not apply to all hospitals. Conclusions These findings demonstrate high inpatient and 100-day mortality in a selected population of oncology patients. The event of an RRT activation may be a useful predictor of prognosis in oncology patients and can be used to help patients and families improve advance care and end-of-life planning.

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Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital

Lyons

Klaus

McEvoy

et al. 2019

JOP

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PURPOSE: Patients hospitalized outside the intensive care unit (ICU) frequently experience clinical deterioration. Little has been done to describe the landscape of clinical deterioration among inpatients with cancer. We aimed to describe the frequency of clinical deterioration among patients with cancer hospitalized on the wards at a major academic hospital and to identify independent risk factors for clinical deterioration among these patients. METHODS: This was a retrospective cohort study at a 1,300-bed urban academic hospital with a 138-bed inpatient cancer center. We included consecutive admissions to the oncology wards between January 1, 2014, and June 30, 2017. We defined clinical deterioration as the composite of ward death and transfer to the ICU. RESULTS: We evaluated 21,219 admissions from 9,058 patients. The composite outcome occurred during 1,945 admissions (9.2%): 1,365 (6.4%) had at least one ICU transfer, and 580 (2.7%) involved ward death. Logistic regression identified several independent risk factors for clinical deterioration, including the following: age (odds ratio [OR], 1.33 per decade; 95% CI, 1.07 to 1.67), male sex (OR, 1.15; 95% CI, 1.05 to 1.33), comorbidities, illness severity (OR, 1.11; 95% CI, 1.10 to 1.13), emergency admission (OR, 1.45; 95% CI, 1.26 to 1.67), hospitalization on particular wards (OR, 1.525; 95% CI, 1.326 to 1.67), bacteremia (OR, 1.24; 95% CI, 1.01 to 1.52), fungemia (OR, 3.76; 95% CI, 1.90 to 7.41), tumor lysis syndrome (OR, 3.01; 95% CI, 2.41 to 3.76), and receipt of antimicrobials (OR, 2.04; 95% CI, 1.72 to 2.42) and transfusions (OR, 1.65; 95% CI, 1.42 to 1.92). CONCLUSION: Clinical deterioration was common; it occurred in more than 9% of admissions. Factors independently associated with deterioration included comorbidities, admission source, infections, and blood product transfusion.

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Utilization Of Rapid Response Resources And Outcomes At A Comprehensive Cancer Center

Cited by 5 publications

References 0 publications

Utilization of a rapid response team and associated outcomes in patients with malignancy

Utilization of a rapid response team and associated outcomes in patients with malignancy

Mortality outcomes in hospitalized oncology patients after rapid response team activation

Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital

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