Miryea Cisneros, Bachelors
Third-year medical student
Medical College of Wisconsin, United States
Disclosure information not submitted.
Paul Bergl, MD
Intensivist
Gundersen Lutheran Medical Center, United States
Disclosure information not submitted.
Title: Risk Factors for Deterioration and Outcomes Among Outpatient Rapid Response Calls
Introduction: Rapid Response Teams (RRTs) reduce rates of cardiac arrest in hospitalized patients, but their effects when responding to non-hospitalized patients and visitors are unknown. We hypothesized that patient characteristics could be used to identify non-hospitalized patients who could benefit from RRT expertise. We defined RRT expertise as indicated when (a.) significant diagnostic testing or interventions occurred during RRT activation or (b.) the patient required hospital-based care afterwards.
Methods: We conducted a retrospective, single-center, cohort study. Subjects were non-hospitalized patients for whom RRT was activated from January 1 to December 31, 2019. Variables included patient demographics, time and location of RRT, vital signs, and activation trigger(s). Outcomes included receipt of medications or diagnostic tests during RRT and disposition after RRT. We gathered data from chart abstraction and performed a series of chi-square analyses and subsequent multivariate logistic regression.
Results: We reviewed 339 non-hospitalized patients with RRT activation. Most RRT activations were for ambulatory patients (71.1%) or visitors or employees (26%). Most activations had multiple triggers (56.6%) and were called for patients with qSOFA of 0-1 (87.3%). The variables independently associated with receipt of any medication during RRT were as follows: multiple RRT triggers (OR 3.7, 95% CI 1.7-8.0), qSOFA 2-3 (OR 3.5, 95% CI 1.6-7.6), and ambulatory patient status (OR 3.3, 95% CI 1.3-8.3) and cardiac or respiratory trigger (OR 2.4, 95% CI 1.3-4.6). Similarly, diagnostic testing was significantly more likely if qSOFA 2-3, RRT lasted at least 30 minutes, or a primary cardiac trigger was present. Only 2 activations (0.5%) progressed to cardiopulmonary arrest.
After activation, 77.9% of patients were transported to the emergency department (ED). Older patients and those with qSOFA 2-3, hypoxemia, or primary cardiac or respiratory trigger were significantly more likely to require subsequent hospital-based care (ED and/or hospitalization).
Conclusions: This study’s findings suggest that RRT expertise is not required for many ambulatory patients and visitors and that patients’ needs can likely be predicted by first triaging vital signs.