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Do ICU Admissions Following Rapid Response Events Differ by Patient Demographics?

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Area of Science:

  • Critical Care Medicine
  • Health Services Research
  • Health Equity

Background:

  • Rapid response systems (RRS) aim to manage clinical deterioration on hospital floors.
  • Disparities in downstream care decisions, especially ICU triage, following RRS activation are not well understood.
  • Investigating demographic influences on ICU admission post-RRS is crucial for equitable care.

Purpose of the Study:

  • To examine the impact of demographic variables on ICU admission decisions after RRS activation.
  • To identify potential biases in critical care triage following RRS events.
  • To inform strategies for reducing unintentional influences in clinical decision-making.

Main Methods:

  • Retrospective analysis of 37,400 RRS activations (2013-2023) at a tertiary academic medical center.
  • Data included patient demographics, service, trigger reasons, and code status.
  • Multivariable logistic regression analyzed odds of ICU transfer, adjusting for multiple variables.

Main Results:

  • Of 13,799 patients, 8.2% transferred to ICU post-RRS.
  • Female sex associated with 13.5% lower odds of ICU admission (OR 0.865; p<0.05).
  • Married status associated with 18.6% higher odds of ICU admission (OR 1.186; p<0.05). Race and age showed no significant association.

Conclusions:

  • Female patients were less likely than male patients to be admitted to the ICU after RRS activation, despite similar clinical criteria.
  • This finding suggests potential disparities in acute care decision-making.
  • Further mixed-methods research is recommended to explore decision-making processes and mitigate unintentional influences.