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Characteristics of Rapid Response Calls in the United States: An Analysis of the First 402,023 Adult Cases From the Get With the Guidelines Resuscitation-Medical Emergency Team Registry

Lyons, Patrick G. MD1; Edelson, Dana P. MD, MS2; Carey, Kyle A. MPH2; Twu, Nicole M. MS2; Chan, Paul S. MD, MS3; Peberdy, Mary Ann MD4; Praestgaard, Amy MS5; Churpek, Matthew M. MD, MPH, PhD2; for the American Heart Association’s Get With the Guidelines – Resuscitation Investigators

doi: 10.1097/CCM.0000000000003912
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Objectives: To characterize the rapid response team activations, and the patients receiving them, in the American Heart Association-sponsored Get With The Guidelines Resuscitation-Medical Emergency Team cohort between 2005 and 2015.

Design: Retrospective multicenter cohort study.

Setting: Three hundred sixty U.S. hospitals.

Patients: Consecutive adult patients experiencing rapid response team activation.

Interventions: Rapid response team activation.

Measurements and Main Results: The cohort included 402,023 rapid response team activations from 347,401 unique healthcare encounters. Respiratory triggers (38.0%) and cardiac triggers (37.4%) were most common. The most frequent interventions—pulse oximetry (66.5%), other monitoring (59.6%), and supplemental oxygen (62.0%)—were noninvasive. Fluids were the most common medication ordered (19.3%), but new antibiotic orders were rare (1.2%). More than 10% of rapid response teams resulted in code status changes. Hospital mortality was over 14% and increased with subsequent rapid response activations.

Conclusions: Although patients requiring rapid response team activation have high inpatient mortality, most rapid response team activations involve relatively few interventions, which may limit these teams’ ability to improve patient outcomes.

1Department of Medicine, Washington University School of Medicine, St. Louis, MO.

2Department of Medicine, University of Chicago, Chicago, IL.

3Department of Internal Medicine, Mid America Heart Institute at St. Luke’s Hospital, University of Missouri-Kansas City, Kansas City, MO.

4Departments of Internal Medicine and Emergency Medicine, Virginia Commonwealth University, Richmond, VA.

5Department Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.

This study was performed at The University of Chicago, Chicago, IL.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Lyons’ institution received funding from a National Institutes of Health (NIH) T32 grant (5T32 HL007317). Drs. Lyons, Chan, and Churpek received support for article research from the NIH. Dr. Edelson’s institution received funding from EarlySense, Tel Aviv, Israel and Philips Healthcare, Andover, MA. Drs. Edelson and Churpek disclosed received funding from a Patent Pending (ARCD.P0535US.P2) for risk stratification algorithms for hospitalized patients. Dr. Chan is supported by a research grant award from the National Institutes of Health (1R01 HL123980). Ms. Praestgaard’s institution received funding from American Heart Association. 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). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Matthew M. Churpek, University of Chicago Medical Center, Section of Pulmonary and Critical Care Medicine, 5841 South Maryland Avenue, MC 6076, Chicago, IL 60637. E-mail: matthew.churpek@uchospitals.edu

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