Modifications to predefined rapid response team calling criteria: prevalence, characteristics and associated outcomes

Standardised rapid response team (RRT) calling criteria may not be applicable to all patients, and thus, modifications of these criteria may be reasonable to prevent unnecessary calls. Little data are available regarding the efficacy or safety of modifying RRT calling criteria; therefore, this study aimed to detail the prevalence and characteristics of modifications to RRT call triggers and explore their relationship with patient outcomes.

A pilot retrospective cohort study within a convenience sample of patients attended by a hospital RRT between July and December 2014; rates of repeat RRT calling and in-hospital mortality were compared between patients with and without modifications to standard calling criteria. Secondary analyses examined four different types of modifications, narrowing or widening of existing physiological calling criteria, to observations without defined calling criteria, and others. All analyses were performed using multivariable regression.

During the study period, 673 patients had RRT calls, of whom 620 (91.2%) had data available for analysis. The majority of study patients (393; 63.4%) had modifications documented. Patients with modifications were more likely to have repeat RRT calls (odds ratio [OR], 2.86; 95% CI, 1.69-4.85) and experience in-hospital mortality (OR, 2.16; 95% CI, 1.31-3.57) versus patients without modifications. In the secondary analyses, although all classes of modification had higher rates of repeat calling, none reached statistical significance. Mortality was associated with having modifications that were more conservative than the standard calling criteria (adjusted OR, 2.81; 95% CI, 1.31-6.08).

Modifications to standard calling criteria were frequently made, but did not seem to prevent further RRT calls and were associated with increased mortality. These findings suggest that modifications should be made with caution.