Patient physiological status during emergency care and rapid response team or cardiac arrest team activation during early hospital admission

OBJECTIVES: The objective of this study was to examine the relationship between rapid response team (RRT) or cardiac arrest team (CAT) activation within 72 h of emergency admission and (i) physiological status in the emergency department (ED) and (ii) risk for ICU admission and in-hospital mortality. <br /><br />METHODS: A retrospective matched cohort study was conducted in three hospitals in Melbourne, Australia. The exposed cohort (n=660) included randomly selected adults admitted to the medical or surgical ward through the ED who had RRT or CAT activation within 72 h of admission. Unexposed matched controls (n=1320) did not have RRT or CAT activation. <br /><br />RESULTS: The exposed cohort was more likely to have physiological abnormalities fulfilling hospital RRT activation criteria during ED care (36.7 vs. 23.8%, P<0.001). After adjusting for confounders, tachypnoea (adjusted odds ratio=1.92, 95% confidence interval: 1.38-2.67) or hypotension (AOR=1.43, 95% confidence interval: 1.00-2.03), fulfilling RRT activation criteria during ED care, was associated with RRT or CAT activation within 72 h of admission. The exposed cohort had more in-hospital deaths (16.5 vs. 3.6%, P<0.001), more unexpected in-hospital deaths (2.05 vs. 0.2%, P<0.001), more ICU admissions (11.8 vs. 0.7%, P<0.001) and longer lengths of hospital stay (median=8 vs. 5 days, P<0.001). <br /><br />CONCLUSION: CAT/RRT activations within 72 h of emergency admission are associated with higher mortality and increased length of stay. Factors associated with CAT/RRT activation in the wards are often identifiable when patients are in the ED. Further studies are required to determine whether early identification and intervention in patients at risk for RRT or CAT activation can improve their eventual outcomes.