Rapid response teams and recommended ward-based management of acute deterioration: a single-centre retrospective cohort study in an inner-city London (UK) teaching hospital.

objectivesTo describe the associations between Rapid Response Team (RRT) patient review and other predefined clinical management actions, with risk of in-hospital cardiac arrest and in-hospital mortality in the first unplanned admission (UPA) to the adult intensive care unit (ICU) from the ward environment for each patient.To describe a novel RRT assessment tool for ward-based care for patients who were deteriorating.

designA retrospective cohort study.

settingA large multispecialty, tertiary referral and teaching hospital in England, UK.

participantsThe study included 3175 consecutive adult ICU UPAs from hospital wards over a 6-year period (2014-2019). OUTCOME MEASURES: Ward-based management of deterioration prior to ICU admission was assessed by the RRT, using a scored checklist-the UPA score. Admissions were compared in two groups according to their exposure to an RRT review in the 72 hours before ICU admission. Associations with in-hospital cardiac arrest within 24 hours before ICU admission and all-cause in-hospital mortality were estimated, using unadjusted and adjusted odds ratios (aORs) with 95%CI.

resultsRRT review occurred in 1413 (44.5%) admissions and was associated with reduced odds of in-hospital cardiac arrest (aOR 0.51; 95% CI 0.36 to 0.78; p<0.001), but similar odds of in-hospital mortality (OR 0.97; 95% CI 0.83 to 1.12; p=0.65). The median (IQR) UPA score was 1 (0 to 2), and each point increase was associated with increased odds of in-hospital cardiac arrest (aOR 1.13; 95% CI 1.06 to 1.23; p<0.001) and in-hospital mortality (aOR 1.10; 95% CI 1.05 to 1.15; p<0.001). Among individual UPA score items, Nursing Escalation Failure, Blood Gas Omission and Laboratory Blood Omission were associated with increased odds of in-hospital cardiac arrest, whereas Delayed Vital Signs and Failure to Recognise Deterioration were associated with increased odds of in-hospital mortality. CONCLUSIONS AND RELEVANCE: An RRT review in the 72 hours prior to ICU admission was associated with reduced odds of in-hospital cardiac arrest but did not impact in-hospital mortality. Higher UPA scores were associated with increased incidence of both in-hospital cardiac arrest and in-hospital mortality. In addition, this study describes a novel and adaptable RRT scoring tool (the UPA score) for safety monitoring and quality improvement.