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The rapid response system and end-of-life care

Jones, Daryla; Moran, Julia; Winters, Bradfordb; Welch, Johnc,d

Current Opinion in Critical Care: December 2013 - Volume 19 - Issue 6 - p 616–623
doi: 10.1097/MCC.0b013e3283636be2
ETHICAL, LEGAL AND ORGANIZATIONAL ISSUES IN THE ICU: Edited by Rinaldo Bellomo and Andrew Hilton

Purpose of review To review the recent observational studies reporting the role of the rapid response team (RRT) in end-of-life care (EOLC) planning for hospitalized patients.

Recent findings Initial RRT studies focussed on its role in detecting and preventing avoidable morbidity. However, patients who are in the process of dying will also trigger RRT activation criteria. Single-centre studies from several countries reveal that up to 25% of RRT calls involve patients with a pre-existing limitation of medical therapy (LOMT) and 10% result in new implementation of a new LOMT. A recent seven hospital study revealed that such EOLC RRT calls occur in significantly older patients, who are less likely to be from home and more likely to be admitted with a nonsurgical condition. Importantly, almost 50% of patients subject to EOLC RRT call die in hospital, and in many cases the last RRT call occurs on the day of death.

Summary Up to one-third of RRT calls involve patients at the end of their life. Better understanding of the features of these patients may guide improved advance care and EOLC planning for hospitalized patients.

aAustin Hospital, Heidelberg, Victoria, Australia

bDepartment of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

cCritical Care, University College London Hospitals NHS Foundation Trust

dCity University, London, UK

Correspondence to Associate Professor Daryl Jones, BSc(Hons), MBBS, FRACP, FCICM, MD, Adjunct Senior Research Fellow, DEPM, Monash University, Consultant, Intensive Care Specialist, Austin Health, Intensive Care Unit, Austin Hospital, Studley Road, Heidelberg, VIC 3084, Australia. Tel: +61 39496 5000; fax: +61 39496 3932; e-mail:

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