New study on intensive rapid response system treatment in end-of-life care
Katie Looze Bronk
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(OAKBROOK TERRACE, Illinois, August 29, 2018) – 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, associate professor of Health Systems Research and Translation, Centre for Research in Evidence-Based Practice, Bond University and Gold Coast Hospital and Health Service, Queensland, Australia, and co-authors, 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 percent 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 percent. 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, Sheba Medical Center, Tel-Hashomer, Israel, and Michael Ehrenfeld, MD, risk management consultant, 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.
Also featured in the September 2018 issue:
- “Developing a Standard Handoff Process for Operating Room-to-ICU Transitions: Multidisciplinary Clinician Perspectives from the Handoffs and Transitions in Critical Care (HATRICC) Study” (University of Pennsylvania Health System, Philadelphia)
- “Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to ‘How’” (Seven nursing homes in Manitoba, Canada)
- “Defibrillator Design and Usability May Be Impeding Timely Defibrillation” (The University of Ottawa and The Ottawa Hospital, Ottawa, Canada)
- “Hospital Leadership Diversity and Strategies to Advance Health Equity” (1,088 U.S. hospitals)
- “Safety Stop: A Valuable Addition to the Pediatric Universal Protocol” (Lucile Packard Children’s Hospital Stanford, Palo Alto, California)
- “Patient Reported Experience Following Ambulatory Procedures of the Nervous System” (Mayo Clinic, Rochester, Minnesota)
For more information, visit The Joint Commission Journal on Quality and Patient Safety website.
Note for editors
The article is “Who Benefits from Aggressive Rapid Response System Treatment Near the End of Life? A Retrospective Cohort Study,” by Magnolia Cardona, PhD, MPH; Robin M. Turner, PhD, MSc; Amanda Chapman, BN, GradDip (Acute Care); Hatem Alkhouri, PhD, MSc; Ebony T. Lewis, MIPH, BN; Stephen Jan, PhD, ME; Margaret Nicholson, MN, DipAppSc; Michael Parr, MBBS, FCICM; Margaret Williamson, MPH, BPharm; and Ken Hillman, MD, FCICM. The article appears in The Joint Commission Journal on Quality and Patient Safety, volume 44, number 9 (September 2018), published by Elsevier.
The editorial is “The Role of Rapid Response Teams in End-of-Life Care,” by Eyal Zimlichman, MD, MSc, and Michael Ehrenfeld, MD. The article appears in The Joint Commission Journal on Quality and Patient Safety, volume 44, number 9 (September 2018), published by Elsevier.
The Joint Commission Journal on Quality and Patient Safety
The Joint Commission Journal on Quality and Patient Safety (JQPS) is a peer-reviewed journal providing health care professionals with innovative thinking, strategies and practices in improving quality and safety in health care. JQPS is the official journal of The Joint Commission and Joint Commission Resources, Inc. Original case studies, program or project reports, reports of new methodologies or the new application of methodologies, research studies, and commentaries on issues and practices are all considered.
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