O RIG IN AL A RTICL ES The mortality associated with review by the rapid response team for non-arrest deterioration: a cohort study of acute hospital adult patients

Fewer than 20% of people who suffer cardiac arrest in hospital survive to hospital discharge. 1,2 Rapid response teams (RRTs) have been introduced with the rationale that early intervention in the care of patients with unexpected clinical deterioration might prevent serious adverse events. 13 Downey and colleagues examined two cohorts of 100 patients who received RRT review for altered conscious state and arrhythmias and found hospital mortality was 35% and 18%, respectively. 14 The study illuminated two important subgroups of patients seen by RRTs, but more information is required to understand who receives RRT review and what happens to these patients. The aims of our study were: to compare the admission characteristics, discharge destination and mortality in the 90 days after admission of patients reviewed by the RRT for non-arrest deterioration with those of patients not reviewed by the RRT; and to determine the association between RRT review for non-arrest deterioration and mortality. Methods The hospital and its rapid response system St Vincent's Hospital is a tertiary hospital for adult patients that is affiliated with the University of Melbourne and situated on the edge of the Melbourne central business district. During the study period (2008)(2009)(2010)(2011), the hospital had about 300 acute ward beds and provided a comprehensive range of medical and surgical subspecialties, including cardiac surgery and neurosurgery, but did not perform solid organ transplantation, other than renal transplantation, and did not provide major trauma or burns services. Commencing in 2002 and continuing throughout the study period, two types of rapid response operated at the hospital: Respond Blue and Respond Medical Emergency Team (MET). These services were available 24 hours a day, seven days a week. Activation (calling) criteria are shown in ABSTRACT Objectives: To compare the admission characteristics, discharge destination and mortality of patients reviewed by the rapid response team (RRT) for deterioration with those of other hospital patients; and to determine the association between RRT review for deterioration and mortality. Design, setting and patients: Acute admissions of adult patients to a tertiary hospital between 1 January 2008 and 31 December 2011 were identified from administrative data. Data for each patient's first admission were merged with RRT data on the first RRT event of each admission, if any. RRT events involving cardiac arrest were classified as arrest events and all others as deterioration events. Results: Of 43 385 patients in the cohort, 1117 (2.57%) had RRT review for deterioration and 91 (0.21%) for cardiac arrest. Deterioration events occurred a median of 3.23 days after admission. Advanced treatments were instituted in 38.59% of deterioration events, and a new not-forresuscitation order for 5.55%. Compared with those not reviewed by the RRT, patients in the deterioration group were older (median, 70 v 60 years, P < 0.001) and had a higher Charlson comorbidity index (median, 1 v 0, P < 0.001). They also more often died in hospital (18.80% v 1.42%, P < 0.001) or were discharged to another hospital (37.51% v 13.39%, P < 0.001) and more often died in the 90 days after admission (24.44% v 3.48%, P < 0.001). Their adjusted odds ratio of death in the 90 days after admission was 5.85 (95% CI, 4.97-6.89, P < 0.001). Conclusion: Patients reviewed for deterioration were older and had greater comorbidity than patients the RRT was not called to review. RRT review for deterioration was an Crit Care Resusc 2014; 16: 119-126 independent risk factor for mortality