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Utilization of Rapid Response Resources and Outcomes in a Comprehensive Cancer Center*

Austin, Charles A. MD1; Hanzaker, Chris BS2; Stafford, Renae MD, MPH, MS, FACS3; Mayer, Celeste PhD4; Culp, Loc RN, BSN5; Lin, Feng-Chang PhD6; Chang, Lydia MD7

Critical Care Medicine:
doi: 10.1097/CCM.0000000000000098
Clinical Investigations
Abstract

Objective: To compare the differences in characteristics and outcomes of cancer center patients with other subspecialty medical patients reviewed by rapid response teams.

Design: A retrospective cohort study of hospitalized general medicine patients, subspecialty medicine patients, and oncology patients requiring rapid response team activation over a 2-year period from September 2009 to August 2011.

Patients: Five hundred fifty-seven subspecialty medical patients required rapid response team intervention.

Setting: A single academic medical center in the southeastern United States (800+ bed) with a dedicated 50-bed inpatient comprehensive cancer care center.

Interventions: Data abstraction from computerized medical records and a hospital quality improvement rapid response database.

Measurements and Main Results: Of the 557 patients, 135 were cancer center patients. Cancer center patients had a significantly higher Charlson Comorbidity Score (4.4 vs 2.9, < 0.001). Cancer center patients had a significantly longer hospitalization period prior to rapid response team activation (11.4 vs 6.1 d, p < 0.001). There was no significant difference between proportions of patients requiring ICU transfer between the two groups (odds ratio, 1.2; 95% CI, 0.8–1.8). Cancer center patients had a significantly higher in-hospital mortality compared with the other subspecialty medical patients (33% vs 18%; odds ratio, 2.2; 95% CI, 1.50–3.5). If the rapid response team event required an ICU transfer, this finding was more pronounced (56% vs 23%; odds ratio, 4.0; 95% CI, 2.0–7.8). The utilization of rapid response team resources during the 2-year period studied was also much higher for the oncology patients with 37.34 activations per 1,000 patient discharges compared with 20.86 per 1,000 patient discharges for the general medical patients.

Conclusions: Oncology patients requiring rapid response team activation have a significantly higher in-hospital mortality rate, particularly if the rapid response team requires ICU transfer. Oncology patients also utilize rapid response team resources at a much higher rate.

Author Information

1Department of Medicine, University of North Carolina, Chapel Hill, NC.

2School of Medicine, University or North Carolina, Chapel Hill, NC.

3Department of Surgery, University or North Carolina, Chapel Hill, NC.

4University of North Carolina Heath Care, Chapel Hill, NC.

5Medical Intensive Care Unit, Department of Nursing, University or North Carolina, Chapel Hill, NC.

6Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC.

7Department of Pulmonary and Critical Care Medicine, University or North Carolina, Chapel Hill, NC.

* See also p. 997.

Dr. Mayer is employed by UNC Health Care. Dr. Lin received support for article research from National Institutes of Health (NIH). His institution received grant support from the NIH(grant: UL1 TR000083). Dr. Chang’s institution received grant support from the NIH (Clinical trials for ARDS network and MIND-USA). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: caaustin@unch.unc.edu

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins