New Study on Intensive Rapid Response System Treatment in End-of-Life Care

Many intensive interventions are delivered after rapid response system (RRS) calls, which are designed to identify and respond to seriously ill patients in acute hospitals. A new study evaluates whether treatment is beneficial for end-of-life care patients for whom an RRS call is made, describes interventions administered, and measures the cost of hospitalization.

The study, "Who Benefits From Aggressive Rapid Response System Treatment Near the End of Life? A Retrospective Cohort Study," by Magnolia Cardona, PhD, MPH, an associate professor of health systems research and translation at the Centre for Research in Evidence-Based Practice at Bond University and Gold Coast Hospital and Health Service in Queensland, Australia, and coauthors, appears in the September 2018 issue of The Joint Commission Journal on Quality and Patient Safety.

The study authors evaluated 733 adult inpatients with data for the period three months before and after their last placed RRS call. A subgroup analysis of admitted patients aged 80 years and older also was conducted.

Findings showed 8.9% of patients had a preexisting not-for-resuscitation (NFR) or not-for-RRS order; none of these patients survived to three months. However, patients without an NFR or not-for-RRS order had a three-month survival probability of 71%. Compared with survivors, RRS recipients who died were more likely to be older, to be admitted to a medical ward, and to have a larger mean number of admissions before the RRS. The average cost of hospitalization for patients aged 80 years and older transferred to the ICU was higher than for those not requiring treatment in the ICU.

"Identifiable risk factors clearly associated with poor clinical outcomes and death can be used as a guide to administer less aggressive treatments, including reconsideration of ICU transfers, adherence to NFR orders, and transition to end-of-life management instead of calls to the RRS team," the study authors conclude.

In an accompanying editorial, "The Role of Rapid Response Teams in End-of-Life Care," Eyal Zimlichman, MD, MSc, chief medical officer of Sheba Medical Center in Tel-Hashomer, Israel, and Michael Ehrenfeld, MD, risk management consultant for Sheba Medical Center, support the idea that to reduce unnecessary interventions, goals of care should be agreed on as early as possible during hospitalization and in advance of any deterioration.

"We recommend that hospitals develop policies and protocols that would enable end-of-life discussions by the treating physician as early as possible into the hospital admission. Appropriate timing should take place so that frontline physicians have adequate skills to perform this task," note the authors.

Source: The Joint Commission Journal on Quality and Patient Safety