Enhanced end‐of‐life care associated with deploying a rapid response team: A pilot study

Abstract

HYPOTHESIS: Institution of a rapid response team (RRT) improves patients' quality of death (QOD). SETTING: A 425‐bed community teaching hospital. PATIENTS: All medical‐surgical patients whose end‐of‐life care was initiated on the hospital wards during the 8 months before (pre‐RRT) and after (post‐RRT) actuation. STUDY DESIGN: Retrospective cohort study. METHODS: Medical records of all patients were reviewed using a uniform data abstraction tool. Demographic information, diagnoses, physiologic and laboratory data, and outcomes were recorded. RESULTS: A total of 197 patients died in both the pre‐RRT and post‐RRT periods. There were no differences in age, sex, advance directives, ethnicity, or religion between groups. Restorative outcomes, including in‐hospital mortality (27 vs. 30/1000 admissions), unexpected transfers to intensive care (17 vs. 19/1000 admissions) and cardiac arrests (3 vs. 2.5/1000 admissions) were similar during the 2 periods. Outcomes, including formal comfort care only orders (68 vs. 46%), administration of opioids (68 vs. 43%), pain scores (3.0 ± 3.5 vs. 3.7 ± 3.2), patient distress (26 vs. 62%), and chaplain visits (72 vs. 60%), were significantly better in the post‐RRT period compared to the pre‐RRT period (all P < 0.05). During the post‐RRT period, 61 patients died with RRT care and 136 died without RRT care. End‐of‐life care outcomes were similar for these groups except more RRT patients had chaplain visits proximate to their deaths (80% vs. 68%; P = 0.0001). CONCLUSIONS: Institution of an RRT in our hospital had negligible impact on outcomes of patients whose goal was restorative care. Deployment of the RRT was associated with generally improved end‐of‐life pain management and psychosocial care. Journal of Hospital Medicine 2009;4:449–452. © 2009 Society of Hospital Medicine.