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Rapid response team integration at a quaternary care academic centre: new paradigm for critical care organistions
  1. Rohit R Gupta,
  2. Cristhian Gonzalez,
  3. Jennifer Wang,
  4. Miguel Martillo,
  5. Roopa Kohli-Seth
  1. Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Rohit R Gupta, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; rohit.gupta{at}mountsinai.org

Abstract

Background Decompensating patients require expeditious and focused care at the bedside. This can be particularly challenging when there are multiple layers of providers, each with differing specialisation, experience and autonomy. We examined the impact of our intensivist-driven hospital-wide rapid response team (RRT) at our 1171-bed quaternary care centre.

Design Single-centre retrospective cohort study.

Methods RRT service was implemented to assess, manage and triage acutely ill patients outside the intensive care unit (ICU). Criteria for consultation and workflow were established. The 24/7 team was led by an intensivist and included nurse practitioners and respiratory therapists. Over 3 years, we reviewed the impact of the RRT on patient outcomes and critical care support beyond the ICU.

Results Over 3 years, the RRT received 31 392 consults for 12 122 individual patients averaging 30 consults over 24 hours. 58.9% of the calls received were for sepsis alerts/risk of decompensation and 41.1% of the consults were for reasons of acute decompensation. Among patients that were seen by the RRT, over the course of their hospital stay, 14% were upgraded to a step-down unit, 18% were upgraded to the ICU and 68% completed care without requiring any escalation. The average mortality rate for patients seen by the RRT service during their hospital stay was 11.3% with an average 30-day readmission rate of 16.5% and average hospital length of stay 16 days without significant variation between the 3 years.

Conclusions Intensivist-led RRT ensured consistent high value care. Early intervention and consistent supervision enabled timely and efficient delivery of critical care services.

  • health policy
  • organisation of health services
  • protocols & guidelines
  • quality in health care
  • intensive & critical care
  • medical education & training
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Footnotes

  • Contributors RRG and RK-S planned the study. RRG and CG collected the data and completed the statistical analysis. RRG, JW, MM and RK-S wrote the manuscript. RRG and RK-S are the guarantors for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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