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Patient Survival and Length of Stay Associated With Delayed Rapid Response System Activation

Padilla, Ricardo M., PhD, MSN, RN, CCRN; Mayo, Ann M., DNSc, RN, FAAN

doi: 10.1097/CNQ.0000000000000264
Original Articles
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The objective of this study was to investigate the difference in mortality and length of stay between patients who experienced a delay in rapid response system (RRS) activation and those who did not. A retrospective comparative cohort study investigated all adult inpatient cases that experienced an RRS activation from January 1, 2017, through January 1, 2018. Cases experiencing a delay in RRS activation were compared with cases without delay. During the study period a total of 3580 RRS activations that took place and 1086 RRS activations met inclusion criteria for analysis. Delayed RRS activations occurred in 325 cases (29.8%) and nondelayed RRS activations occurred in 766 cases (70.2%). The mean age was roughly the same for both groups (60 years old) and both groups consisted of approximately 60% males. Delay in activation was significantly associated with an increase in length of hospitalization (19.9 days vs 32.4 days; P < .001) and also a higher likelihood of not surviving hospitalization (hazard ratio = 2.70; 95% confidence interval, 1.96-3.71; P < .001). This study demonstrates that delayed RRS activation occurs frequently and exposes patients to higher mortality and longer length of hospitalization.

Beyster Institute for Nursing Research, University of San Diego Hahn School of Nursing and Health Science, California (Drs Padilla and Mayo); and Department of Nursing Education, Development, and Research, University of California San Diego Health System, California (Dr Padilla).

Correspondence: Ricardo M. Padilla, PhD, MSN, RN, CCRN, Beyster Institute for Nursing Research, University of San Diego Hahn School of Nursing and Health Science, 5998 Alcalá Park, San Diego, CA 92110 (rpadilla@sandiego.edu).

The authors thank Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN, Professor, and Kathleen M. Stacy, PhD, RN, APRN-CNS, CCNS, Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, California; Dale Glaser, PhD, Statistician, Glaser Consulting, San Diego, California; Murray Keogh, Senior Data Analyst, Calvin Fong, Clinical Informatics Specialist, Mary Belich, RN, MN, Clinical Quality Improvement Specialist, and Code Blue and RRT Committee, UC San Diego Health System, San Diego, California.

The primary author of this article received funding from the University of San Diego, Hahn School of Nursing and Health Science, in the form of the PhD Dean's Scholar Award.

Work performed at the University of California San Diego Health System; the University of San Diego, Hahn School of Nursing and Health Science.

The authors declare no conflicts of interest.

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