Association between time of day for rapid response team activation and mortality

To evaluate the frequency of rapid response team (RRT) calls by time of day and their association with in-hospital mortality. This was a retrospective cohort study of all RRT calls at a tertiary teaching hospital in Porto Alegre, Brazil. Patients were categorized according to the time of initial RRT...

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Bibliographic Details
Published in:	Journal of critical care Vol. 77; p. 154353
Main Authors:	Boniatti, Márcio Manozzo, de Loreto, Melina Silva, Mazzutti, Geris, Benedetto, Igor Gorski, John, Josiane França, Zorzi, Lia Andrade, Prestes, Marcius Conceição, Viana, Marina Verçoza, dos Santos, Moreno Calcagnotto, Buttelli, Thais Crivellaro Dutra, Nedel, Wagner, Nunes, Diego Silva Leite, Barcellos, Guilherme Brauner, Neyeloff, Jeruza Lavanholi, Dora, Jose Miguel, Lisboa, Thiago Costa
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-10-2023 Elsevier Limited
Subjects:	Blood pressure Consciousness Heart rate Hypotheses Intensive care unit Mortality Nurses Nursing Ostomy Oxygen saturation Patients Rapid response team Statistical analysis Variables Vital signs Mortality Intensive care unit Rapid response team
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Summary:	To evaluate the frequency of rapid response team (RRT) calls by time of day and their association with in-hospital mortality. This was a retrospective cohort study of all RRT calls at a tertiary teaching hospital in Porto Alegre, Brazil. Patients were categorized according to the time of initial RRT activation. Activations were classified as daytime (7:00–18:59) or nighttime (19:00–6:59). The primary outcome was in-hospital mortality rate. The secondary outcome was ICU admission within 48 h of RRT assessment. During the study period, 4522 patients were included in the final analysis. Cardiovascular and respiratory changes were more common causes of nighttime activation, whereas neurological and laboratory changes were more common during the daytime. The in-hospital mortality rate was 23.9% (1081/4522). Nighttime RRT calls were not associated with worse outcomes than daytime calls. However, a decrease in the number of calls was observed during nursing handover periods (7:00, 13:00 and 19:00). Two time periods were associated with increased adjusted odds for mortality: 12:00–13:00 (adjusted OR 2.277; 95% CI 1.392–3.725) and 19:00–20:00 (adjusted OR 1.873; CI 1.873; 95% 1.099–3.190). We found that nighttime RRT calls were not associated with worse outcomes than daytime RRT calls. However, a decrease in the number of calls and higher mortality was observed during nursing handover periods. •Nighttime RRT calls did not have higher mortality risk, unlike prior research.•Possible reasons: 24/7 intensivist in RRT and consistent nurse-to-patient ratio day-night in our study.•A decrease in the number of calls and higher mortality was observed during nursing handover periods
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0883-9441 1557-8615
DOI:	10.1016/j.jcrc.2023.154353