Rapid response team patients triaged to remain on ward despite deranged vital signs: missed opportunities?

Background Rapid response teams (RRTs) triage most patients to stay on ward, even though some of them have deranged vital signs according to RRTs themselves. We investigated the prevalence and outcome of this RRT patient cohort. Methods A prospective observational study was conducted in a Finnish te...

Full description

Saved in:
Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2017-11, Vol.61 (10), p.1278-1285
Main Authors: Tirkkonen, J., Kontula, T., Hoppu, S.
Format: Article
Language:English
Subjects:
Aged
Female
Hospital Mortality
Hospital Rapid Response Team
Humans
Male
Medical personnel
Middle Aged
Mortality
Patients
Prospective Studies
Regression Analysis
Risk groups
Triage
Vital Signs
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Rapid response teams (RRTs) triage most patients to stay on ward, even though some of them have deranged vital signs according to RRTs themselves. We investigated the prevalence and outcome of this RRT patient cohort. Methods A prospective observational study was conducted in a Finnish tertiary referral centre, Tampere University Hospital. Data on RRT activations were collected between 1 May 2012 and 30 April 2015. Vital signs of patients triaged to stay on ward without treatment limitations were classified according to objective RRT trigger criteria observed during the reviews. Results During the study period, 860 patients had their first RRT review and were triaged to stay on ward. Of these, 564 (66%) had deranged vital signs, while 296 (34%) did not. RRT patients with deranged vital signs were of comparable age and comorbidity index as stable patients. Even though the patients with deranged vital signs had received RRT interventions, such as fluids and medications, more often than the stable patients, they required new RRT reviews more often and had higher in‐hospital and 30‐day mortality. Moreover, the former group had substantially higher 1‐year mortality than the latter (37% vs. 29%, P = 0.014). In a multivariate regression analysis, deranged vital signs during RRT review was found to be independently associated with 30‐day mortality (OR 1.74; 95% CI 1.12–2.70). Conclusion Patients triaged to stay on ward despite deranged vital signs are high‐risk patients who could benefit from routine follow‐up by RRT nurses before they deteriorate beyond salvation.
ISSN:0001-5172
1399-6576
DOI:10.1111/aas.12993