Outcome of Patients before and after Implementation of RRT in a Tertiary Hospital

ABSTRACT

Aim and background: Although the evidence for rapid response team (RRT) effectiveness remains uncertain, RRT are implemented across many hospitals in the world. We aimed to determine the impact of RRT on outcomes in our hospital. Materials and methods: Our hospital is a 30-bedded non-COVID-19 tertiary care teaching hospital. We collected prospective observational data after implementation of the RRT (February 1, 2021, to September 30, 2021, RRT Period) for a period of 8 months and compared it with retrospective cohort data for 8 months before implementation (February 1, 2020, to September 30, 2020, control period). We conduct a 12th hourly team round consists of a Critical care physician, Anesthesiologist, Duty RMO, Duty Medical officer, and Nurse Supervisor. All the ward patients in the hospital were charted with a Modified early warning score (MEWS) and RRT enrollment will be done if the score is >5 or a single variable score of 3. If the final MEWS ≥ 7 will be transferred immediately to the ICU. The outcomes monitored were hospital mortality and morbidity. Results: During the Control period (February 2020 to September 2020), we analyzed 5522 hospital admissions and 18951 patient days of which 77 patients were transferred to ICU, and mean age of these patients is 55.17 years. Male patients were 53, average length of stay post ICU transfer 4.27 days, of transferred patients medical are 66 and surgical are 11. Death of ICU transferred patients is 14. Number of code blue and death in the ward during this period is 22 and 21, respectively. During RRT period, we analyzed 6956 hospital admissions and 24072 patient days of which 83 patients were transferred to ICU, and mean age of these patients is patients is 58.12, male patients were 55, average length of stay post ICU transfer 3.6 days of which medical are 53 and surgical are 30. Death in ICU transferred patients is 8. Number of code blue and death in the ward during this period is 25 and 43 respectively. Of 43 ward deaths 18 contribute for DNR. Most common reason for transfer to ICU is respiratory failure, Oncology patients were predominant in both groups. The RRT was activated 83 times (11.9 calls per 1,000 patients and 3.44 calls per 1,000 patient-days). The Code blue rate for Control vs RRT were 1.16 and 1.03 per 1,000 patient days, respectively. The hospital mortality for control vs RRT were 1.84 and 1.78 per 1,000 patient days, respectively. The length of stay for control vs RRT were 0.22 and 0.14 per 1,000 patient days, respectively. The ICU mortality of transferred patients for Control vs RRT were 0.73 and 0.33 per 1,000 patient days, respectively. We found a decrease in the trend in code blue rate and hospital mortality in the ward, length of stay, and mortality in ICU transferred patients in the RRT period compared with the control period. Conclusion: We observed a trend towards decline in mortality and morbidity after implementation of RRT, and continuing for a longer duration may give us robust data.