PURPOSE: The functional processes of Rapid Response Teams (RRT) in the oncological population have not been previously studied. Our objective was to analyze the RRT clinical triggers and resolution of RRT calls in oncologic patients.
METHODS: Using ICU and hospital databases, we retrospectively analyzed all RRT calls at a tertiary cancer center between 1/1/09 and 12/31/09. The RRT was comprised of Critical Care Medicine (CCM) nurse practitioners (NPs) and respiratory therapists supported by CCM physicians. Data collected were admitting service (medical, surgical, neurology, or others), patient status (inpatient/outpatient/non-patient), primary person requesting RRT, RRT clinical trigger, and resolution (ICU admission, CCM consult follow-up, ward care, and RRT refused).
RESULTS: Of the 686 RRT calls, 406 (59%) were medical patients, 217 (32%) were surgical, 31 (4.5%) were neurology, and 32 (4.5%) were from other services. Most RRT calls were for inpatients (n=648, 94%); the rest were for outpatients (n=20, 3%) and non-patients (n=18, 3%). RRT activators were predominantly nurses (n=550, 80%) followed by house staff (n=57, (8%), NP/PA (n=43, 6%), and others (n=36, 5%). The triggers for RRT calls were acute coronary syndrome (ACS) (n=301, 44%), hemodynamic instability include code activation (n=161, 23%), respiratory insufficiency (n=118, 17%), neurological derangement (n=80, 12%), and miscellaneous (n=26, 4%). Only 12 (1.7%) of ACS calls ruled in. Over 50% of RRT calls (n=355, 52%) were resolved by the RRT on the requesting unit. 116 (17%) of the RRT calls were admitted to the ICU within 24 hours. Another 146 (21%) were followed on the unit by the CCM consult service. 33 (5%) calls were declined, 24 (4%) died and 12 (1%) were transferred to another hospital.
CONCLUSION: At our cancer center, RRT calls are predominantly triggered by nurses for medical inpatients, and largely for cardiovascular and respiratory symptoms. Almost 40% of the RRT calls required critical care intervention.
CLINICAL IMPLICATIONS: Critical care evaluation and ICU admission can be facilitated by a RRT call as an alternative to the traditional physician-initiated CCM consult.
DISCLOSURE: Yaketerina Tayban, No Financial Disclosure Information; No Product/Research Disclosure Information