PURPOSE: Rapid response teams (RRTs) were created to stabilize acutely ill patients on the ward, but recent studies suggest that RRTs may improve end-of-life care (EOLC). To learn more about the role of the RRT in EOLC at our institutions, we conducted a retrospective review. METHODS: Retrospective review of 300 RRT consultations at 3 academic hospitals in Toronto, Canada. RESULTS: The typical consultation was for an elderly patient with chronic illness. More than 90% had a "full resuscitation" order at the time of consultation. One third were admitted to the intensive care unit within 48 hours of the RRT consultation, and 24.7% ultimately died. Twenty-seven (9.3%) had a patient/family conference on the ward within 48h of the RRT consultation, 24 (8.3%) of whom changed their resuscitation order as a result. Among those who changed their resuscitation order, fewer than 20% were referred to the palliative care or spiritual care service, or prescribed comfort medications as needed (pro re nata), within 48 h of the RRT consultation; 2 patients died without receiving any common EOLC orders, and 15 (63%) died before discharge. CONCLUSIONS: RRT consultation is an important milestone for many patients approaching EOL. RRTs frequently participate in EOL discussions and decision-making, but they may miss opportunities to facilitate EOLC.
PURPOSE: Rapid response teams (RRTs) were created to stabilize acutely ill patients on the ward, but recent studies suggest that RRTs may improve end-of-life care (EOLC). To learn more about the role of the RRT in EOLC at our institutions, we conducted a retrospective review. METHODS: Retrospective review of 300 RRT consultations at 3 academic hospitals in Toronto, Canada. RESULTS: The typical consultation was for an elderly patient with chronic illness. More than 90% had a "full resuscitation" order at the time of consultation. One third were admitted to the intensive care unit within 48 hours of the RRT consultation, and 24.7% ultimately died. Twenty-seven (9.3%) had a patient/family conference on the ward within 48h of the RRT consultation, 24 (8.3%) of whom changed their resuscitation order as a result. Among those who changed their resuscitation order, fewer than 20% were referred to the palliative care or spiritual care service, or prescribed comfort medications as needed (pro re nata), within 48 h of the RRT consultation; 2 patients died without receiving any common EOLC orders, and 15 (63%) died before discharge. CONCLUSIONS: RRT consultation is an important milestone for many patients approaching EOL. RRTs frequently participate in EOL discussions and decision-making, but they may miss opportunities to facilitate EOLC.
Authors: Judith E Nelson; Kusum S Mathews; David E Weissman; Karen J Brasel; Margaret Campbell; J Randall Curtis; Jennifer A Frontera; Michelle Gabriel; Ross M Hays; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Stefanie P Weiss; Rick Bassett; Renee D Boss; Dana R Lustbader Journal: Chest Date: 2015-02 Impact factor: 9.410
Authors: Nita Khandelwal; Ann C Long; Robert Y Lee; Cara L McDermott; Ruth A Engelberg; J Randall Curtis Journal: Lancet Respir Med Date: 2019-05-20 Impact factor: 30.700
Authors: Rachel Whitty; Sandra Porter; Kiran Battu; Pranjal Bhatt; Ellen Koo; Csilla Kalocsai; Peter Wu; Kendra Delicaet; Isaac I Bogoch; Robert Wu; James Downar Journal: CMAJ Open Date: 2018-02-16
Authors: Paul R Duberstein; Michael Chen; Michael Hoerger; Ronald M Epstein; Laura M Perry; Sule Yilmaz; Fahad Saeed; Supriya G Mohile; Sally A Norton Journal: J Pain Symptom Manage Date: 2019-10-19 Impact factor: 3.612