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Outpatient Utilization of the Rapid Response Team FREE TO VIEW

Gina Iacovella, MS; Alice Gallo de Moraes; Ronaldo Sevilla Berrios; John O'Horo, MPH; Jennifer Elmer; Sean Caples; Jeffrey Jensen
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Critical Care, Mayo Clinic, Rochester, MN

Chest. 2014;146(4_MeetingAbstracts):564A. doi:10.1378/chest.1993270
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SESSION TITLE: Patient Safety Initiative Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The concept of an “ICU without walls” has allowed for the early identification of patient deterioration and subsequent mobilization and assessment by a multi-disciplinary critical care team via Rapid Response Team (RRT) activations. (1, 2) Value of a RRT is the immediate availability of critical care expertise to a non-ICU patient. The literature has focused predominantly on the use of RRT in hospitalized patients, but none has related to the outpatient population. We have asked whether RRT activations in the outpatient setting warranted a critical care intervention.

METHODS: The integrated practice of our tertiary teaching medical center exposes the hospital based RRT to both in-patient and outpatient interactions. We performed a retrospective review focused in those RRT activations that involved outpatient evaluations only. We evaluated the cause of RRT activation, the level of interventions during the RRT, frequency of subsequent Emergency Department (ED) evaluations, hospital admissions, and ICU admissions.

RESULTS: During the 2 month observation period, there were a total of 224 RRT activations; 207 (92%) inpatients and 17 (8%) outpatients. The most common causes for RRT activations were pulmonary (29%), cardiovascular (18%), and gastrointestinal (18%). Obtaining peripheral intravenous access was the most common intervention, which occurred in 24% of cases (4/17). Among the outpatient RRT activations, 13 patients were transported to the ED for further evaluation/triage and 2 patients were directly admitted to the hospital. From the total outpatients evaluated, 58.8% (10/17) were admitted to the general wards and 20% (2/10) of patients required ICU level of care.

CONCLUSIONS: Despite more than half of the outpatient RRT activations requiring hospital admission, none required a critical care intervention during the actual RRT event.

CLINICAL IMPLICATIONS: Although outpatient RRT evaluations make up a minority of activations, this observation requires a larger study to evaluate ideal team composition for this population of patients.

DISCLOSURE: The following authors have nothing to disclose: Gina Iacovella, Alice Gallo de Moraes, Ronaldo Sevilla Berrios, John OHoro, Jennifer Elmer, Sean Caples, Jeffrey Jensen

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