M. Chang1, P. Sinha2, P. Ayoung-Chee2 1St. George’s University School Of Medicine,St. George’s, St. George’s, Grenada 2New York University School Of Medicine,Department Of Surgery,New York, NY, USA
Introduction:
Rapid response teams (RRT) have been shown to decrease cardiac arrests and unexpected deaths while increasing the number of admissions to the intensive care unit (ICU). They are alerted when patients display clinical signs of deterioration, bringing a team comprised of critical care nurses and a medical intensivist. At our institution, surgical patients with post-operative complications were not benefiting from RRT activations. Therefore, we implemented a surgical rapid response team (SRRT) with the goal of improving surgical patient outcomes. The SRRT alerted a surgical intensivist and the in-house surgical resident team in addition to the usual RRT members. The goal of this study was to evaluate the impact of the SRRT implementation.
Methods:
We completed a retrospective study of 87 total RRTs involving surgical patients in the six months prior to the implementation of the SRRT (period 1) and in the eight months after (period 2). For each RRT, we measured the time elapsed from the initiation of the RRT to the time of intervention. An intervention was defined as prescribing medication, infusing intravenous fluids, intubating the patient or beginning cardiopulmonary resuscitation. Additional outcomes included the time that elapsed from the initiation of the RRT to the admission of the patient to the ICU and the time that elapsed from the initiation of the RRT to the patient’s return to the OR.
Results:
There were 26 total RRTs in period 1 and 61 SRRTs in period 2. This represented a 75.9% increase in RRTs in surgical patients after the implementation of the SRRT. In our analysis, 8 RRTs from period 1 and 18 SRRTs from period 2 were excluded due to missing time to intervention. The average time to intervention decreased significantly from 12.2 mins in period 1 to 7.4 mins in period 2, a decrease of 4.8 mins (CI 1.37 – 8.21, P=0.0068). For patients who required ICU admission, the average time to ICU admission decreased from 40.9 mins in period 1 to 27.0 mins in period 2, a difference of 13.9 mins (CI 10.22 – 37.97, P=0.2458). For patients who required a return to the OR, the average time decreased from 66.5 mins in period 1 to 26.0 mins in period 2, a decrease of 40.5 mins (CI -61.70 – 142.70, P=0.2303).
Conclusion:
Creating a surgery-specific RRT decreased the time to intervention by nearly 40% for surgical patients. The time to ICU admission and time to return to the OR were also decreased, although not statistically significant. Additionally, there was a disproportionate increase in RRTs called on surgical patients after the implementation of the SRRT. We were unable to evaluate why there was an increase in RRTs but having a surgery-specific RRT may represent a resource staff feel comfortable using when their patients show clinical signs of deterioration. This study shows promising results for improved outcomes with a surgery-specific RRT.