Rapid Response Team activation in New Zealand hospitals—a multicentre prospective observational study

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

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A review of rapid response team activation parameters in New Zealand hospitals

Resuscitation ◽

10.1016/j.resuscitation.2013.01.022 ◽

2013 ◽

Vol 84 (8) ◽

pp. 1040-1044 ◽

Cited By ~ 23

Author(s):

Alex Psirides ◽

Jennifer Hill ◽

Sally Hurford

Keyword(s):

New Zealand ◽

Activation Parameters ◽

Rapid Response Team ◽

Rapid Response ◽

Response Team

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

Critical Care Medicine ◽

10.1097/ccm.0000000000004353 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Judit Orosz ◽

Michael Bailey ◽

Andrew Udy ◽

David Pilcher ◽

Rinaldo Bellomo ◽

...

Keyword(s):

New Zealand ◽

Rapid Response Team ◽

Rapid Response ◽

Icu Admission ◽

Response Team ◽

Hospital Wards

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The impact of proactive rounding on rapid response team calls: an observational study

Hospital Practice ◽

10.1080/21548331.2019.1546529 ◽

2018 ◽

Vol 47 (1) ◽

pp. 42-45

Author(s):

Areeba Kara ◽

Dawson Frank Dean ◽

Cynthia S Johnson ◽

Siu L Hui

Keyword(s):

Observational Study ◽

Rapid Response Team ◽

Rapid Response ◽

Response Team ◽

The Impact

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Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2021238 ◽

2021 ◽

Vol 50 (11) ◽

pp. 838-847

Author(s):

Ken Junyang Goh ◽

Hui Zhong Chai ◽

Lit Soo Ng ◽

Joanna Phone Ko ◽

Deshawn Chong Xuan Tan ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Prospective Observational Study ◽

Rapid Response Team ◽

Rapid Response ◽

Haematological Cancer ◽

Goals Of Care ◽

Icu Admission ◽

Response Team ◽

Second Tier

Introduction: A second-tier rapid response team (RRT) is activated for patients who do not respond to first-tier measures. The premise of a tiered response is that first-tier responses by a ward team may identify and correct early states of deterioration or establish goals of care, thereby reducing unnecessary escalation of care to the RRT. Currently, utilisation and outcomes of tiered RRTs remain poorly described. Methods: A prospective observational study of adult patients (age ≥18 years) who required RRT activations was conducted from February 2018 to December 2019. Results: There were 951 consecutive RRT activations from 869 patients and 76.0% patients had a National Early Warning Score (NEWS) ≥5 at the time of RRT activation. The majority (79.8%) of patients required RRT interventions that included endotracheal intubation (12.7%), point-of-care ultrasound (17.0%), discussing goals of care (14.7%) and intensive care unit (ICU) admission (24.2%). Approximately 1 in 3 (36.6%) patients died during hospitalisation or within 30 days of RRT activation. In multivariate analysis, age ≥65 years, NEWS ≥7, ICU admission, longer hospitalisation days at RRT activation, Eastern Cooperative Oncology Group performance scores ≥3 (OR [odds ratio] 2.24, 95% CI [confidence interval] 1.45–3.46), metastatic cancer (OR 2.64, 95% CI 1.71–4.08) and haematological cancer (OR 2.78, 95% CI 1.84–4.19) were independently associated with mortality. Conclusion: Critical care interventions and escalation of care are common with second-tier RRTs. This supports the need for dedicated teams with specialised critical care services. Poor functional status, metastatic and haematological cancer are significantly associated with mortality, independent of age, NEWS and ICU admission. These factors should be considered during triage and goals of care discussion. Keywords: Clinical deterioration, critical care, intensive care, mortality, rapid response system, rapid response team

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Faculty Opinions recommendation of Hospital-wide code rates and mortality before and after implementation of a rapid response team.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1135962.593069 ◽

2008 ◽

Author(s):

Michael O'Connor

Keyword(s):

Rapid Response Team ◽

Rapid Response ◽

Before And After ◽

Response Team

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Mise en place et organisation d’une équipe médicale mobile de réponse précoce aux urgences intra-hospitalières (Rapid Response Team)

Médecine Intensive Réanimation ◽

10.37051/mir-00018 ◽

2020 ◽

Author(s):

Boris Jung ◽

Gerald Chanques ◽

Samir Jaber ◽

Kada Klouche

Keyword(s):

Rapid Response Team ◽

Rapid Response ◽

Prise En Charge ◽

Response Team

La mise en place d’une Rapid Response Team a pour objectif la mise en place d’une structure de réponse hospitalièrepour la prise en charge des urgences vitales et surtout une réponse précoce à la dégradation clinique des patientshospitalisés avant que l’urgence vitale ne survienne. Nous discutons dans ce manuscrit le rationnel et le niveau depreuve motivant la mise en place d’une Rapid Response Team ainsi que les freins qui doivent être surmontés pour lesuccès de cette mise en place.

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