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

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Manoj Singh
2. Ramprasad Vegunta
3. Sumeet Rai
4. Krishna Karpe
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23322
Volume
24
Issue
1
Publishing Year
2020
Pages
5
Author Affiliations
1. com.mps.common.model.Contributor@16897774 ,
2. com.mps.common.model.Contributor@5122c42f ,
3. com.mps.common.model.Contributor@2d07d0c2 ,
4. com.mps.common.model.Contributor@13bd6e18
Article 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

Abstract

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.

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