Rapid response teams

Introduction

• Staff to review acutely unwell inpatients to reduce cardiac arrests and serious adverse events
• When doctor is in RRT = MET
• Should have ability to:
  • Prescribe appropriate therapies
  • Advanced airway management
  • Insertion of invasive vascular lines
  • Commencement of ICU level care at bedside
  • Quality improvement
  • Clinical governance
  • Hospital-wide strategy to prevent recurrence

Underlying principles

• SAE’s are common in hospitalised patients
  • 7.5-16.6% rate of SAW’s and 36.9-51% were deemed preventable
  • 17% of major surgery patients suffer at least one SAW
• SAE’s are preceded by signs of instability for up to 24 hours
  • New complaints, deterioration of vital signs or derangement of lab investigations in up to 84%
  • Increased risk of death if vital signs meet MET criteria
• Deterioration is typically gradual
  • Allows prevention
• Early intervention improves outcome
  • Trauma, MI and sepsis all been shown to have improved outcomes with early intervention
• Skilled staff already exist in the hospital

ED patients who develop instability

• Unplanned ICU admission is a largely preventable SAW for general ward patients associated with a 10-fold increase in mortality
• 70% of patients admitted to ICU from ED have been shown to recognised as critically ill on arrival (Triage 1 or 2)
• Approximately 1% of non-resus patients fulfil MET criteria and 1.5% of ED patients suffer deterioration warranting a local ED rapid response
• Independent predictors of admission in ED patients
  • HR >130, SBP <100, RR >30 and temp >38.5
• Independent predictors of in-hospital death
  • SBP <100/>200, RR >30 and decreased conscious state on ED arrival
• Hypotension during ED care significantly increases in-hospital risk of death in trauma and non-trauma patients

Predictors of unplanned icu admission from inpatients

• Male
• Older age
• Higher acuity triage category
• Co-morbid conditions
• Sepsis
• AKI
• Haematological neoplasms
• Pneumonia
• COPD
• Bowel obstruction

MERIT study

• Cluster randomised trial of 23 hospital
• 12 with MET, 11 with usual care
• No reduction in cardiac arrests, unplanned ICU admissions or unexpected deaths
• Issues
  • Very short education period prior to MET introduction
  • Low call rate
  • 30% of patients admitted to ICU with MET criteria did not actually have a MET call

Last Updated on July 19, 2021 by Andrew Crofton