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OBJECTIVE: The study aimed to evaluate the effect of a single after-hours rapid response team (RRT) calls on patient outcome. DESIGN: A retrospective cohort study of RRT-call data over a 3-year period. SETTING: A 600-bedded, tertiary referral, public university hospital. PARTICIPANTS: All adult patients who had a single RRT-call during their hospital stay. INTERVENTION: None. MAIN OUTCOMES MEASURES: The primary outcome was to compare all-cause in-hospital mortality. The secondary outcomes were to study the hourly variation of RRT-calls and the mortality rate. RESULTS: Of the total 5,108 RRT-calls recorded, 1,916 patients had a single RRT-call. Eight hundred and sixty-one RRT-calls occurred during work-hours (08:00-17:59 hours) and 1,055 during after-hours (18:00-7:59). The all-cause in-hospital mortality was higher (15.07% vs 9.75%, OR 1.64, 95% CI 1.24-2.17, p value 0.001) in patients who had an after-hours RRT-call. This difference remained statistically significant after multivariate regression analysis (OR 1.50, 95% CI 1.11-2.01, p value 0.001). We noted a lower frequency of hourly RRT-calls after-hours but were associated with higher hourly mortality rates. There was no difference in outcomes for patients who were admitted to ICU post-RRT-call. CONCLUSION: Patients having an after-hour RRT-call appear to have a higher risk for hospital mortality. No causal mechanism could be identified other than a decrease in hourly RRT usage during after-hours. HOW TO CITE THIS ARTICLE: Singh MY, Vegunta R, Karpe K, Rai S. Does the Time of Solitary Rapid Response Team Call Affect Patient Outcome? Indian J Crit Care Med 2020;24(1):38-43.
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OBJECTIVE: To assess the frequency of after-hours discharges of patients from the intensive care unit and its effect on in-hospital mortality. DESIGN, SETTING AND PARTICIPANTS: Observational cohort study conducted in the ICU of Westmead Hospital, a tertiary care teaching hospital in Sydney. All adult patients admitted to the ICU between 1 January 2004 and 31 December 2006 were included in the study cohort. Patients were grouped into two categories based on the time of discharge from the ICU: during work hours (08:00-17:59 hours) or after-hours (18:00-07:59 hours). MAIN OUTCOME MEASURE: Mortality after discharge from the ICU according to time of discharge. MEASUREMENTS AND MAIN RESULTS: 2300 patients accounted for 2451 admission episodes during the study period. There were 151 readmissions, involving 133 patients (5.8%). Excluded from the study cohort were 36 patients (1.6%) who were discharged home, 39 (1.7%) who were transferred to other hospitals, and 354 (15.4%) who died during their first stay in the ICU. Data on the remaining 1871 patients who were discharged alive at the end of their first ICU admission were included in our analysis. Of these patients, 1221 (65.3%) were discharged from the ICU during work-hours and 650 (34.7%) after-hours. Crude mortality for patients discharged after-hours was 13.7%, compared with 10.1% for those discharged during work hours. After adjustment for age, APACHE II score and discharge destination, the risk of mortality among patients discharged after-hours was statistically significant (adjusted odds ratio, 1.38 [95% CI, 1.01-1.88]; P < 0.05). CONCLUSIONS: A high proportion of patients (34.7%) were discharged from the ICU after-hours. Discharge after-hours was associated with a higher risk of in-hospital mortality than discharge during work hours.