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.
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.