Abstract P104: Patients’ Functional Outcomes After the Intervention of a Rapid Response Team (RRT)
Objectives: To evaluate patient outcomes at discharge for RRT activations outside the intensive care unit (ICU).
Methods: Consecutive cohort of patients that required the activation of a RRT for in-hospital deterioration. The Overall Performance Category Scale (OPC) was assessed at hospital admission and dismissal.
Results: There were 1,745 calls to the RRT team from 09/2006 – 02/2009; 83.4% in non-monitored beds, 8.6% in telemetry beds, 4.8% in outpatient procedure rooms, and 3.2% in other hospital areas. There were 1,166 calls (66.8%) on medical services, 476 (27.3%) on surgical areas, and 5.9% in other areas including radiology and procedure rooms. Common criteria for activation were respiratory distress or low O2 saturation in 38.0%, hypotension or tachycardia in 21.9%, and altered consciousness (LOC) in 21.7%. There were 249 patients (14.3%) with Do Not Resuscitate (DNR) status at the time of the RRT activation, and 149 patients changed their status from Full Code to DNR after the RRT intervention. Disposition after the event was transfer to ICU in 57%, no location change in 33.6%, death in 0.4% and other locations in 9%. OPC was available for 1,669 patients: 18.2% in-hospital deaths [OPC 5], 0.4% coma [OPC 4], 8.6% severe overall disability [OPC 3], 39.3% moderate overall performance [OPC 2] and 33.6% good overall performance [OPC 1]. Predictors of OPC score >=3 at dismissal were older age (p<0.0001), high initial score (p<0.0001), admission to a medical service as compared to surgical service (RR 2.4, p<0.0001), and respiratory cause as a primary activation criteria, p<0.001. When compared to admission, 57% had deterioration of OPC score at discharge. Predictors of deterioration were older age (median age 60 vs 70 years, p<0.0001), high initial score (p<0.0001), admission to a medical service as compared to surgical service (RR 1.1, 95%CI 1.01–1.23, p=0.021)
Conclusion: More than half of the patients will have some deterioration in their overall performance score after the hospitalization, in particular older patients and those with high initial scores. Predictors of poor performance scores were initial high scores, older age, dismissal from a medical service as compared to a surgical service, and having a respiratory cause as a primary activation criteria.