To evaluate characteristics and outcome of ICU patients admitted from general wards based on mode of admittance, via a rapid response team or conventional contact.
Observational prospective study.
General ICU of a university hospital.
A total of 694 admissions to ICU from general wards.
Between 2007 and 2009, two cohorts admitted to ICU from general wards were identified: those admitted by the rapid response team and those admitted in a conventional way. Patients admitted directly from the trauma room, the emergency department, operating room, other hospitals, or other ICUs were excluded. Of 694 admissions, 355 came through a rapid response team call. Rapid response team patients were older (p < 0.01), and they had more severe comorbidities, higher severity score (p < 0.01), and almost three times more often the diagnosis of severe sepsis (p < 0.01) than conventionally admitted patients. Rapid response team patients had higher ICU mortality and 30-day mortality with a crude odds ratio for mortality within 30 days of 1.57 (95% confidence interval 1.08–2.28). Adjusted for age and comorbidities however, the difference was no longer significant with an odds ratio of 1.11 (95% confidence interval 0.70–1.76).
This study suggests that the rapid response team is an important system for identifying complex patients in need of intensive care. More than half of ICU admissions from the wards came through a rapid response team call. Compared with conventional admissions, rapid response team patients had a high proportion of characteristics that could be related to a worse prognosis. Severe sepsis at the wards was mainly detected by the rapid response team and was the most common admitting diagnosis among the rapid response team patients. When adjusted for confounding factors, outcome between the groups did not differ, supporting the use of rapid response systems to identify deteriorating ward patients.
1 Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
2 Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
3 Department of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden.
* See also p. 911.
Institution where the work was done: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Solna, Sweden and the department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Supported, in part, by grants from the Laerdal Foundation and funds from the Karolinska Institutet.
Dr. Martling received grant support from Stockholm County Council. Dr. Ekbom received payment for lectures from MSD, AstraZeneca and Centocor. The remaining authors have not disclosed any potential conflicts of interest.
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