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VOLUME 24 , ISSUE 1 ( January, 2020 ) > List of Articles


Does the Time of Solitary Rapid Response Team Call Affect Patient Outcome?

Manoj Y Singh, Ramprasad Vegunta, Krishna Karpe, Sumeet Rai

Keywords : After-hour MET-call, After-hour RRT-call, Emergency medical team call, Hospital mortality, Medical emergency team call, Rapid response system call, Work-hour MET-call, Work-hour RRT-call

Citation Information : Singh M Y, Vegunta R, Karpe K, Rai S. Does the Time of Solitary Rapid Response Team Call Affect Patient Outcome?. Indian J Crit Care Med 2020; 24 (1):38-43.

DOI: 10.5005/jp-journals-10071-23322

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2020; The Author(s).


Objective: The study aimed to evaluate the effect of a single after-hours rapid response team (RRT) calls on patient outcome. Design: A retrospective cohort study of RRT-call data over a 3-year period. Setting: A 600-bedded, tertiary referral, public university hospital. Participants: All adult patients who had a single RRT-call during their hospital stay. Intervention: None. Main outcomes measures: The primary outcome was to compare all-cause in-hospital mortality. The secondary outcomes were to study the hourly variation of RRT-calls and the mortality rate. Results: Of the total 5,108 RRT-calls recorded, 1,916 patients had a single RRT-call. Eight hundred and sixty-one RRT-calls occurred during work-hours (08:00–17:59 hours) and 1,055 during after-hours (18:00–7:59). The all-cause in-hospital mortality was higher (15.07% vs 9.75%, OR 1.64, 95% CI 1.24–2.17, p value 0.001) in patients who had an after-hours RRT-call. This difference remained statistically significant after multivariate regression analysis (OR 1.50, 95% CI 1.11–2.01, p value 0.001). We noted a lower frequency of hourly RRT-calls after-hours but were associated with higher hourly mortality rates. There was no difference in outcomes for patients who were admitted to ICU post-RRT-call. Conclusion: Patients having an after-hour RRT-call appear to have a higher risk for hospital mortality. No causal mechanism could be identified other than a decrease in hourly RRT usage during after-hours.

  1. Becker DJ. Do hospitals provide lower quality care on weekends? Health Serv Res 2007;42(4):1589–1612. DOI: 10.1111/j.1475-6773.2006.00663.x.
  2. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med 2011;364(11):1037–1045. DOI: 10.1056/NEJMsa1001025.
  3. Tong PK. The effects of California minimum nurse staffing laws on nurse labor and patient mortality in skilled nursing facilities. Health Econ 2011;20(7):802–816. DOI: 10.1002/hec.1638.
  4. Mitra B, Cameron PA, Fitzgerald MC, Bernard S, Moloney J, Varma D, et al. “After-hours” staffing of trauma centres and outcomes among patients presenting with acute traumatic coagulopathy. Med J Aust 2014;201(10):588–591. DOI: 10.5694/mja13.00235.
  5. Wood SD, Coster S, Norman I. Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after-hours with day transfers: an exploratory, prospective cohort study. J Adv Nurs 2014;70(12):2757–2766. DOI: 10.1111/jan.12410.
  6. Schwartz DA, Medina M, Cotton BA, Rahbar E, Wade CE, Cohen AM, et al. Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. J Trauma Acute Care Surg 2014;76(1):134–139. DOI: 10.1097/TA.0b013e3182ab0cfc.
  7. Ting JY, Humphrey KJ. After hours medical ward duties in a teaching hospital. Aust Health Rev 2005;29(1):37–42. DOI: 10.1071/AH050037.
  8. Ansa V, Otu A, Oku A, Njideoffor U, Nworah C, Odigwe C. Patient outcomes following after-hours and weekend admissions for cardiovascular disease in a tertiary hospital in Calabar, Nigeria. Cardiovasc J Afr 2016;27(5):328–332. DOI: 10.5830/CVJA-2016-025.
  9. Lee KG, Indralingam V. A study of weekend and off-hour effect on mortality in a public hospital in Malaysia. Med J Malaysia 2012;67(5):478–482.
  10. Singh MY, Nayyar V, Clark PT, Kim C. Does after-hours discharge of ICU patients influence outcome? Crit Care Resusc 2010;12(3):156–161.
  11. Trinkle RM, Flabouris A. Documenting rapid response system afferent limb failure and associated patient outcomes. Resuscitation 2011;82(7):810–814. DOI: 10.1016/j.resuscitation.2011.03.019.
  12. Sandroni C, Cavallaro F. Failure of the afferent limb: a persistent problem in rapid response systems. Resuscitation 2011;82(7):797–798. DOI: 10.1016/j.resuscitation.2011.04.012.
  13. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008;299(7):785–792. DOI: 10.1001/jama.299.7.785.
  14. Chan PS, Krumholz HM, Nichol G, Nallamothu BK, American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 2008;358(1):9–17. DOI: 10.1056/NEJMoa0706467.
  15. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005;365(9477):2091–2097. DOI: 10.1016/S0140-6736(05)66733-5.
  16. Salvatierra G, Bindler RC, Corbett C, Roll J, Daratha KB. Rapid response team implementation and in-hospital mortality. Crit Care Med 2014;42(9):2001–2006. DOI: 10.1097/CCM.0000000000000347.
  17. Ludikhuize J, Brunsveld-Reinders AH, Dijkgraaf MG, Smorenburg SM, de Rooij SE, Adams R, et al. Outcomes associated with the nationwide introduction of rapid response systems in The Netherlands. Crit Care Med 2015;43(12):2544–2551. DOI: 10.1097/CCM.0000000000001272.
  18. Brunsveld-Reinders AH, Ludikhuize J, Dijkgraaf MG, Arbous MS, de Jonge E, COMET study group. Unexpected versus all-cause mortality as the endpoint for investigating the effects of a rapid response system in hospitalized patients. Crit Care 2016;20(1):168. DOI: 10.1186/s13054-016-1339-9.
  19. Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care 2015;19:254. DOI: 10.1186/s13054-015-0973-y.
  20. Solomon RS, Corwin GS, Barclay DC, Quddusi SF, Dannenberg MD. Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: a systematic review and meta-analysis. J Hosp Med 2016;11(6):438–445. DOI: 10.1002/jhm.2554.
  21. Chen J, Bellomo R, Flabouris A, Hillman K, Assareh H, Ou L. Delayed emergency team calls and associated hospital mortality: a multicenter study. Crit Care Med 2015;43(10):2059–2065. DOI: 10.1097/CCM.0000000000001192.
  22. Barwise A, Thongprayoon C, Gajic O, Jensen J, Herasevich V, Pickering BW. Delayed rapid response team activation is associated with increased hospital mortality, morbidity, and length of stay in a tertiary care institution. Crit Care Med 2016;44(1):54–63. DOI: 10.1097/CCM.0000000000001346.
  23. Sundararajan K, Flabouris A, Thompson C. Diurnal variation in the performance of rapid response systems: the role of critical care services-a review article. J Intensive Care 2016;4:15. DOI: 10.1186/s40560-016-0136-5.
  24. Psirides AJ, Hill J, Jones D. Rapid response team activation in New Zealand hospitals-a multicentre prospective observational study. Anaesth Intensive Care 2016;44(3):391–397. DOI: 10.1177/0310057X1604400314.
  25. Flabouris A, Chen J, Hillman K, Bellomo R, Finfer S, MERIT Study Investigators from the Simpson Centre, et al. Timing and interventions of emergency teams during the MERIT study. Resuscitation 2010;81(1):25–30. DOI: 10.1016/j.resuscitation.2009.09.025.
  26. Medical Emergency Team End-of-Life Care investigators. The timing of rapid-response team activations: a multicentre international study. Crit Care Resusc 2013;15(1):15–20.
  27. Churpek MM, Edelson DP, Lee JY, Carey K, Snyder A, American Heart Association's Get With The Guidelines-Resuscitation Investigators. Association between survival and time of day for rapid response team calls in a national registry. Crit Care Med 2017;45(10):1677–1682. DOI: 10.1097/CCM.0000000000002620.
  28. Fernando SM, Reardon PM, Bagshaw SM, Scales DC, Murphy K, Shen J, et al. Impact of nighttime rapid response team activation on outcomes of hospitalized patients with acute deterioration. Crit Care 2018;22(1):67. DOI: 10.1186/s13054-018-2005-1.
  29. Calzavacca P, Licari E, Tee A, Mercer I, Haase M, Haase-Fielitz A, et al. Features and outcome of patients receiving multiple medical emergency team reviews. Resuscitation 2010;81(11):1509–1515. DOI: 10.1016/j.resuscitation.2010.06.017.
  30. Jones-Crawford JL, Parish DC, Smith BE, Dane FC. Resuscitation in the hospital: circadian variation of cardiopulmonary arrest. Am J Med 2007;120(2):158–164. DOI: 10.1016/j.amjmed.2006.06.032.
  31. Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, et al. Patient monitoring and the timing of cardiac arrests and medical emergency team calls in a teaching hospital. Intensive Care Med 2006;32(9):1352–1356. DOI: 10.1007/s00134-006-0263-x.
  32. Herlitz J, Bang A, Alsen B, Aune S. Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation 2002;53(2):127–133. DOI: 10.1016/S0300-9572(02)00014-X.
  33. Jaderling G, Bell M, Martling CR, Ekbom A, Bottai M, Konrad D. ICU admittance by a rapid response team versus conventional admittance, characteristics, and outcome. Crit Care Med 2013;41(3):725–731. DOI: 10.1097/CCM.0b013e3182711b94.
  34. Le Guen MP, Tobin AE, Reid D. Intensive care unit admission in patients following rapid response team activation: call factors, patient characteristics and hospital outcomes. Anaesth Intensive Care 2015;43(2):211–215. DOI: 10.1177/0310057X1504300211.
  35. Downar J, Barua R, Rodin D, Lejnieks B, Gudimella R, McCredie V, et al. Changes in end of life care 5 years after the introduction of a rapid response team: a multicentre retrospective study. Resuscitation 2013;84(10):1339–1344. DOI: 10.1016/j.resuscitation.2013.03.003.
  36. ANZICS-CORE MET dose investigators. Mortality of rapid response team patients in Australia: a multicentre study. Crit Care Resusc 2013;15(4):273–278.
  37. Stelfox HT, Bagshaw SM, Gao S. Characteristics and outcomes for hospitalized patients with recurrent clinical deterioration and repeat medical emergency team activation. Crit Care Med 2014;42(7):1601–1609. DOI: 10.1097/CCM.0000000000000315.
  38. Considine J, Charlesworth D, Currey J. Characteristics and outcomes of patients requiring rapid response system activation within hours of emergency admission. Crit Care Resusc 2014;16(3):184–189.
  39. Calzavacca P, Licari E, Tee A, Egi M, Haase M, Haase-Fielitz A, et al. A prospective study of factors influencing the outcome of patients after a medical emergency team review. Intensive Care Med 2008;34(11):2112–2116. DOI: 10.1007/s00134-008-1229-y.
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