OBJECTIVE: To establish and test the feasibility of measurement of a comprehensive set of mutually exclusive outcomes in the 7 days after referral of patients to a rapid-response team (RRT), to facilitate audit and aid analysis of failure-to-rescue events. DESIGN, SETTING AND PARTICIPANTS: Observational cohort study of RRTs in a district general hospital and a university hospital in the United Kingdom. PARTICIPANTS: Patients seen by two RRTs after local track-and-trigger systems were triggered. MAIN OUTCOME MEASURES: An agreed set of patient-centred outcomes tested at Days 1, 3 and 7 after RRT call-out. Positive outcomes were defined as transfer to a critical care unit (CCU) within 4 hours of the trigger event, improved track-and-trigger scores, death without attempted cardiopulmonary resuscitation, decision about treatment limitation, new pathology, chronic pathology or hospital discharge. Negative outcomes were delayed transfer to a CCU, lack of improvement in track-and-trigger scores, death after cardiopulmonary arrest, or loss to follow-up. RESULTS: In the initial pilot study, 75% of patients achieved positive outcomes on Day 1 after RRT call-out, and there were no significant changes to outcomes on Days 3 and 7. A higher rate of negative outcomes was seen in patients who triggered an RRT call-out at night. There was significant variation in outcomes between clinical specialties. In neither of the centres were events reported that could not be classified using our matrix of outcomes. CONCLUSION: It is possible to classify RRT episodes using readily available data, and areas with suboptimal performance can be targeted. Our matrix may additionally facilitate comparison of rapid-response systems.
OBJECTIVE: To establish and test the feasibility of measurement of a comprehensive set of mutually exclusive outcomes in the 7 days after referral of patients to a rapid-response team (RRT), to facilitate audit and aid analysis of failure-to-rescue events. DESIGN, SETTING AND PARTICIPANTS: Observational cohort study of RRTs in a district general hospital and a university hospital in the United Kingdom. PARTICIPANTS: Patients seen by two RRTs after local track-and-trigger systems were triggered. MAIN OUTCOME MEASURES: An agreed set of patient-centred outcomes tested at Days 1, 3 and 7 after RRT call-out. Positive outcomes were defined as transfer to a critical care unit (CCU) within 4 hours of the trigger event, improved track-and-trigger scores, death without attempted cardiopulmonary resuscitation, decision about treatment limitation, new pathology, chronic pathology or hospital discharge. Negative outcomes were delayed transfer to a CCU, lack of improvement in track-and-trigger scores, death after cardiopulmonary arrest, or loss to follow-up. RESULTS: In the initial pilot study, 75% of patients achieved positive outcomes on Day 1 after RRT call-out, and there were no significant changes to outcomes on Days 3 and 7. A higher rate of negative outcomes was seen in patients who triggered an RRT call-out at night. There was significant variation in outcomes between clinical specialties. In neither of the centres were events reported that could not be classified using our matrix of outcomes. CONCLUSION: It is possible to classify RRT episodes using readily available data, and areas with suboptimal performance can be targeted. Our matrix may additionally facilitate comparison of rapid-response systems.
Authors: Herman G Kreeftenberg; Ashley J R De Bie; Eveline H J Mestrom; Alexander J G H Bindels; Peter H J van der Voort Journal: PLoS One Date: 2022-08-23 Impact factor: 3.752