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Association Between Survival and Time of Day for Rapid Response Team Calls in a National Registry

Churpek, Matthew Michael MD, MPH, PhD1; Edelson, Dana P. MD, MS1; Lee, Ji Yeon MD2; Carey, Kyle MPH1; Snyder, Ashley MPH1; for the American Heart Association’s Get With The Guidelines-Resuscitation Investigators

doi: 10.1097/CCM.0000000000002620
Clinical Investigations

Objectives: Decreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether rapid response team call frequency suffers from decreased utilization at night and how this is associated with patient outcomes.

Design: Retrospective analysis of a prospectively collected registry database.

Setting: National registry database of inpatient rapid response team calls.

Patients: Index rapid response team calls occurring on the general wards in the American Heart Association Get With The Guidelines-Medical Emergency Team database between 2005 and 2015 were analyzed.

Interventions: None.

Measurements and Main Results: The primary outcome was inhospital mortality. Patient and event characteristics between the hours with the highest and lowest mortality were compared, and multivariable models adjusting for patient characteristics were fit. A total of 282,710 rapid response team calls from 274 hospitals were included. The lowest frequency of calls occurred in the consecutive 1 am to 6:59 am period, with 266 of 274 (97%) hospitals having lower than expected call volumes during those hours. Mortality was highest during the 7 am hour and lowest during the noon hour (18.8% vs 13.8%; adjusted odds ratio, 1.41 [1.31–1.52]; p < 0.001). Compared with calls at the noon hour, those during the 7 am hour had more deranged vital signs, were more likely to have a respiratory trigger, and were more likely to have greater than two simultaneous triggers.

Conclusions: Rapid response team activation is less frequent during the early morning and is followed by a spike in mortality in the 7 am hour. These findings suggest that failure to rescue deteriorating patients is more common overnight. Strategies aimed at improving rapid response team utilization during these vulnerable hours may improve patient outcomes.

1Department of Medicine, University of Chicago, Chicago, IL.

2Department of Medicine, Emory University, Atlanta, GA.

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Drs. Churpek and Edelson disclosed that they have a patent pending (ARCD. P0535US.P2) for risk stratification algorithms for hospitalized patients. Dr. Churpek received support from the National Institutes of Health, and he is supported by a career development award from the National Heart, Lung, and Blood Institute (K08 HL121080). Dr. Edelson’s institution received funding from EarlySense (Tel Aviv, Israel) and Philips Healthcare (Andover, MA). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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