Characterizing Rapid Response Team Activations at a Community Hospital

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

Am J Respir Crit Care Med

Keywords

adult, altered state of consciousness, Black person, Caucasian, cerebrovascular accident, community hospital, conference abstract, data warehouse, dyspnea, female, heart arrest, heart arrhythmia, human, hypotension, hypoxia, intensive care unit, major clinical study, male, Michigan, nurse, prevention, rapid response team, renal replacement therapy, resuscitation, seizure, thorax pain

Abstract

RATIONALE: Rapid response teams (RRT) were envisioned when resource utilization on treating inpatient cardiac arrest rather than their prevention was questioned. Signs and symptoms of deterioration often precede cardiac arrest. Internal Medicine residents at Providence Hospital in Southfield, Michigan respond to rapid response activations (RRAs). This study was conducted to characterize these events; we describe the demographics, lengths of stay (LOS), reasons for activation, and outcomes of RRAs. METHODS: Approval was granted by the North Central Institutional Review Board of Ascension Health. Day time rapid response events (7 AM - 7PM) were documented via recording sheets from July 2022 through March 2024. Data from the Ascension Michigan Data Warehouse was collected for comparison from all admitted patients during the same period as above. RESULTS: 17,525 admitted patients from Providence Hospital were included. 247 records were missing demographic data. RRAs occurred 912 times on 783 unique patients; 103 patients had multiple responses. There was a difference in age for patients with RRAs compared to those who did not (63.3 versus 67.3 years, p<0.001). There was no difference in sex (p = 0.64); there was a difference in race with black patients having a 4% rate of RRAs, white having 3%, both of which were greater than other racial groups (p<0.001). Mean LOS for all inpatient was 5.4 days, and 12.2 days for patients requiring RRAs (p<0.001). The primary diagnoses for patients requiring RRAs were diseases of the circulatory system (14.3%) and infections (22.4%). 40% of RRAs were for altered mental status, 16.3% for chest pain, 12% for hypotension, 8.7% for arrythmia, 5% for hypoxia, 5% for seizure, and 5% for shortness of breath. Most patients were stabilized on the floor, even those requiring multiple RRAs, 65% and 81% respectively. 13.9% were transferred to an intensive care unit, 6% transferred to an acuity adaptable unit, 6% resulted in code stroke, and 1.5% resulted in code blue. CONCLUSION: RRAs primarily occurred for altered mental status, followed by chest pain, hypotension, arrythmia, hypoxia and shortness of breath. Patients admitted for diseases of the circulatory system or infection had the highest rates. Black race, increasing age and increasing LOS were associated with higher rates of RRAs. Most patients were stabilized on the floor; some required transfer to a higher acuity unit. Review of RRT data can help target areas of education for residents and nurses, while possibly identifying patients at higher risk for decompensation.

Volume

211

Issue

Supplement 1

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