Oncology Inpatient Resuscitation Planning and Long-Term "Rapid Response Call" Outcomes

Resuscitation plans document the mutually agreed medical care of hospital inpatients in an acute deterioration, including decisions regarding cardiopulmonary resuscitation (CPR), rapid response calls (RRCs), and other specific interventions. The aim of this study was to examine the resuscitation plan completion rate among all medical oncology inpatients after the introduction of a 100% completion target. We concurrently examined the outcomes of medical oncology inpatients subject to a RRC to investigate medium- and long-term patient outcomes.

A prospective real-time longitudinal audit of resuscitation plan completion was conducted of all medical oncology admissions over 3 months. Completion of a resuscitation form at any time, and within 72 h, was recorded. RRC information was obtained from the preceding 6 months. RRC data included event time and trigger, patient tumor type and treatment intent, available resuscitation plan at RRC, patient disposition after RRC, survival to discharge, and to future cancer treatment.

Of 326 hospitalizations, 60% included a completed resuscitation form and 56% within 72 h. There were 53 RRCs in 39 individual patients. Most RRCs were after hours (64%) and without an available resuscitation plan (92%). Additionally, 91% of RRCs were in patients receiving palliative cancer treatment; 53% did not survive to discharge, and 76% received no further systemic cancer treatment.

Resuscitation plan completion remains significantly below the aspirational 100% and requires targeted implementation strategies. A proportion of oncology patients receiving palliative cancer treatment continue to be managed in hospital without a resuscitation plan and undergo RRCs despite a poor prognosis.