Evaluation of the five-year operation period of a rapid response team led by an intensive care physician at a university hospital

Mezzaroba, Ana Luiza; Tanita, Marcos Toshiyuki; Festti, Josiane; Carrilho, Claudia Maria Dantas de Maio; Cardoso, Lucienne Tibery Queiroz; Grion, Cintia Magalhães Carvalho

doi:10.5935/0103-507X.20160045

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ORIGINAL ARTICLES • Rev. bras. ter. intensiva 28 (03) • Jul-Aug 2016 • https://doi.org/10.5935/0103-507X.20160045 copy

Evaluation of the five-year operation period of a rapid response team led by an intensive care physician at a university hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the implementation of a multidisciplinary rapid response team led by an intensive care physician at a university hospital.

Methods:

This retrospective cohort study analyzed assessment forms that were completed during the assessments made by the rapid response team of a university hospital between March 2009 and February 2014.

Results:

Data were collected from 1,628 assessments performed by the rapid response team for 1,024 patients and included 1,423 code yellow events and 205 code blue events. The number of assessments was higher in the first year of operation of the rapid response team. The multivariate analysis indicated that age (OR 1.02; 95%CI 1.02 - 1.03; p < 0.001), being male (OR 1.48; 95%CI 1.09 - 2.01; p = 0.01), having more than one assessment (OR 3.31; 95%CI, 2.32 - 4.71; p < 0.001), hospitalization for clinical care (OR 1.77; 95%CI 1.29 - 2.42; p < 0.001), the request of admission to the intensive care unit after the code event (OR 4.75; 95%CI 3.43 - 6.59; p < 0.001), and admission to the intensive care unit before the code event (OR 2.13; 95%CI 1.41 - 3.21; p = 0.001) were risk factors for hospital mortality in patients who were seen for code yellow events.

Conclusion:

The hospital mortality rates were higher than those found in previous studies. The number of assessments was higher in the first year of operation of the rapid response team. Moreover, hospital mortality was higher among patients admitted for clinical care.

Keywords:
Hospital rapid response team; Hospital mortality; Hospital, universities; Patient safety; Intensive care units

	Code yellow events per 1,000 admissions	OR (95%CI)^* * p < 0.001 using a chi-square test for the overall trend.	Code blue events per 1,000 admissions	OR (95%CI)^* * p < 0.001 using a chi-square test for the overall trend.
Year 1	102.15	1	12.91	1
Year 2	42.1	0.39 (0.33 - 0.46)	4.54	0.35 (0.22 - 0.56)
Year 3	37.78	0.35 (0.29 - 0.41)	6.55	0.50 (0.33 - 0.76)
Year 4	44.8	0.41 (0.35 - 0.48)	6.74	0.52 (0.35 - 0.78)
Year 5	49.12	0.45 (0.39 - 0.53)	8.93	0.69 (0.47 - 1.01)

	Code yellow events	Code blue events
Age (years)	61.9 (18.19)	63.02 (17.66)
Male gender	54.9	51.2
Diagnosis at admission
CPAD/AAO	11.4	11.7
Fractures	9.8	12.2
S/SAH	9.2	15.1
EL/PSC	5.9	4.9
Pneumonia	5.4	2.4
Hematologic cancers	2.6	4.9
Others	55.7	48.8
Surgical care	56	57.6
Period 1 (minutes)	1 (0 - 5)	0 (0 - 1)
Period 2 (minutes)	2 (1 - 3)	1 (0 - 2)
Period 3 (minutes)	33 (19 - 57)	29 (15 - 45)
Transfer to the ICU	27.1	5.4
Transfer to palliative care	5.3	7.8

Reasons	N (%)
Hospital team was seriously concerned about the patient	536 (37.7)
Peripheral oxygen saturation lower than 90%	459 (32.3)
Changes in respiratory rate	398 (28.0)
Systolic blood pressure lower than 90 mmHg	383 (26.9)
Decreased level of consciousness	358 (25.2)
Changes in heart rate	231 (16.2)
Seizures	98 (6.9)
Systolic blood pressure higher than 180 mmHg	50 (3.5)

Activities	N (%)
Guidelines
Call the physician responsible for defining individual therapy	112 (7.9)
Request a physical therapist	51 (3.6)
Insertion of central venous access	42 (3.0)
Discussion of the limitations of the therapeutic support	17 (1.2)
Indication of surgical approaches	3 (0.2)
Other	202 (14.2)
Procedures
Return the patient to mechanical ventilation	312 (21.9)
Endotracheal intubation	245 (17.2)
Insertion of central venous catheter	93 (6.5)
Aspiration via oral cavity, endotracheal tube, or tracheostomy	72 (5.1)
Use of a Sengstaken-Blakemore balloon	3 (0.2)
Other	47 (3.3)
Treatments
Volume prescription	395 (27.8)
Vasoactive drugs	362 (25.4)
Antibiotics	265 (18.6)
Sedation	211 (14.8)
Other	751 (52.8)
Tests
Hematological and biochemical tests	370 (26.0)
Chest radiography	222 (15.6)
Blood culture, urine culture, or tracheal aspirate culture	168 (11.8)
Electrocardiography	165 (11.6)
Computed tomography	63 (4.4)
Other	28 (2.0)

Variables	Univariate			Multivariate^* * Logistic regression analysis using the forward stepwise method;
Variables	OR	95%CI	p-value	OR	95%CI	p-value
Age (years)	1.02	1.02 - 1.03	< 0.001	1.02	1.02 - 1.03	< 0.001
Male gender	1.48	1.9 - 2.1	0.01	1.48	1.09 - 2.01	0.01
More than one code event	3.31	2.32 - 4.71	< 0.001	3.31	2.32 - 4.71	< 0.001
Clinical patients	1.77	1.29 - 2.42	< 0.001	1.77	1.29 - 2.42	< 0.001
Time (min)^† † Time between the diagnosis of changes in the clinical status and the activation of the rapid response team;	0.99	0.99 - 1.00	0.91
Request for admission to the ICU^‡ ‡ Request for admission to the ICU after the code event;	4.75	3.43 - 6.59	< 0.001	4.75	3.43 - 6.59	< 0.001
Admission to the ICU before the code event^§ § Request for admission to the ICU before the code event (patients previously admitted to the ICU in the same hospitalization).	2.13	1.41 - 3.21	< 0.001	2.13	1.41 - 3.21	< 0.001

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[1] Corresponding author: Cintia Magalhães Carvalho Grion, Divisão de Terapia intensiva do Hospital Universitário da Universidade Estadual de Londrina, Rua Robert Koch, 60 - Vila Operária, Zip Code: 86038-440 - Londrina (PR), Brazil, E-mail: cintiagrion@hotmail.com