PURPOSE: Rapid Response Team (RRT) calls provide a safety net for hospitalized patients. In theory, medical staff should welcome the support of the RRT; however, we have observed that some RRT calls were declined by the inpatient physicians and thus not evaluated by RRT. The purpose of this study was to investigate the appropriateness of the RRT declined calls.
METHODS: Using ICU and hospital databases, we retrospectively analyzed all declined inpatient RRT calls at a tertiary cancer center during a 6-month period (July 1, 2009- December 31, 2009). The RRT team was comprised of critical care medicine (CCM) nurse practitioners and respiratory therapists supported by CCM physicians. RRT data included: admitting service and acute interventions. RRT decline was deemed inappropriate if ICU admission occurred within 36 hours of the declined RRT call.
RESULTS: There were a total of 342 inpatient RRT calls during the study period. Of these, 17 (5%) were declined. RRT declines were more common among surgical than medical patients (53% vs. 41%). Of the 17 declined RRT calls, 6 (35%) were subsequently admitted to the ICU and deemed inappropriate declines. Four of the 6 patients (67%) required intubation and mechanical ventilation and 2 patients (33%) required vasopressors. The remaining 11 patients (65%) were managed by the primary service and did not warrant critical care intervention or admission 36 hours after the RRT call.
CONCLUSION: While only a small percentage (5%) of RRT calls were declined, a substantial number of these calls required eventual ICU admission.
CLINICAL IMPLICATIONS: Hospitals should recognize that RRT calls may be declined and realize that in some cases, these declines may not be appropriate.
DISCLOSURE: Rhonda D'Agostino, No Financial Disclosure Information; No Product/Research Disclosure Information