Rapid response team diagnoses: frequencies and related hospital mortality

To describe the frequency and hospital mortality of problems (diagnoses) encountered by a rapid response team (RRT), and to identify the most common diagnoses for RRT triggers and for treating units.

For each RRT event in 2015 at a tertiary hospital for adults, we chose the diagnosis that best explained the RRT event from a pre-defined list after reviewing relevant test results and clinical notes.

There were 937 RRT events during 700 admissions and there were 58 different RRT diagnoses in 11 diagnosis groups. The largest groups were neurological and consciousness problems (22.9%), circulatory problems (19.0%) and breathing problems (16.0%). The most common diagnoses were rapid atrial fibrillation (7.6%) and oversedation or narcosis (4.8%). When SpO₂ < 90% triggered RRT review, the leading diagnoses were complex respiratory failure (25.9%) and pneumonia (11.4%). When decreased conscious state triggered review, the main problems were neurological, but there were 39 different diagnoses among these cases. The main problems among orthopaedic cases were post-operative hypovolaemia (19.0%) and spinal anaesthetic-related or epidural analgesicrelated hypotension (15.2%). Hospital mortality was 101/700 (14.4%). Diagnoses with high mortality included gastrointestinal bleeding (4/17, 23.5%), complex respiratory failure (8/33, 24.2%), intracranial event (8/28, 28.6%), cardiogenic shock or acute heart failure (5/17, 29.4%), pneumonia (7/21, 33.3%), chest sepsis (5/11, 45.5%) and cardiac arrest (18/26, 69.2%).

The RRT activation trigger provides only a general indication of the diagnosis. Some problems appear preventable and could provide a focus for unit-based quality initiatives. The mortality of some diagnoses is substantial, and this may help in setting treatment goals, but more work is needed to understand the association of RRT diagnosis and outcome.