Characteristics and outcomes of patients with repeat rapid response team activations in a tertiary centre in...

Rapid response teams (RRTs) are prevalent in healthcare institutions worldwide. Repeated activations are associated with increased morbidity and higher resource utilisation, and represent a heterogeneous population that may benefit from early identification. To date, there are no published data on repeat RRT activations in Singapore. We aimed to compare the characteristics and outcomes between patients who required single versus multiple RRT activations.

We conducted a prospective cohort study of daytime RRT activations from February 2018 to June 2020 in Singapore General Hospital. Repeat activations were defined as patients who had two or more activations during their admission. Patient demographics, clinical characteristics, RRT interventions, patient disposition after activation and hospital length of stay were recorded. The primary outcome of interest was in-hospital mortality.

A total of 1055 patients were included, with 85 requiring repeat RRT activations. There was no significant difference in comorbidities and functional performance status at the time of first activation between patients with single versus repeated activations. Patients with repeat activations had more days in hospital before their index activation, a longer hospital length of stay and higher in-hospital mortality. Repeat activations had the strongest association with mortality on multivariate analysis.

Our study found that repeat RRT activations were significantly associated with higher in-hospital mortality rates and increased hospital length of stay, independent of age, performance status and comorbidities. The results of our study highlight the need for early recognition and intervention in this patient group and discussion on goals of care when appropriate.