Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study

Magnolia Cardona, Robin M. Turner, Amanda Chapman, Hatem Alkhouri, Ebony T. Lewis, Stephen Jan, Margaret Nicholson, Michael Parr, Margaret Williamson, Ken Hillman

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Background: Many patients near the end of life are subject to rapid response system (RRS) calls. A study was conducted in a large Sydney teaching hospital to identify a cutoff point that defines nonbeneficial treatment for older hospital patients receiving an RRS call, describe interventions administered, and measure the cost of hospitalization. Methods: This was a retrospective cohort of 733 adult inpatients with data for the period three months before and after their last placed RRS call. Subgroup analysis of patients aged ≥ 80 years was conducted. Log-rank, chi-square, and t-tests were used to compare survival, and logistic regression was used to examine predictors of death. Results: Overall, 65 (8.9%) patients had a preexisting not-for-resuscitation (NFR) or not-for-RRS order; none of those patients survived to three months. By contrast, patients without an NFR or not-for-RRS order had three-month survival probability of 71% (log-rank χ2 145.63; p < 0.001). 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 the very old transferred to the ICU was higher than for those not requiring treatment in the ICU (US$33,990 vs. US$14,774; p = 0.045). Conclusion: 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.

Original languageEnglish
Pages (from-to)505-513
Number of pages9
JournalJoint Commission Journal on Quality and Patient Safety
Volume44
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018
Externally publishedYes

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Cohort Studies
Retrospective Studies
Resuscitation
Hospitalization
Therapeutics
Resuscitation Orders
Costs and Cost Analysis
Survival
Chi-Square Distribution
Teaching Hospitals
Survivors
Inpatients
Logistic Models

Cite this

Cardona, Magnolia ; Turner, Robin M. ; Chapman, Amanda ; Alkhouri, Hatem ; Lewis, Ebony T. ; Jan, Stephen ; Nicholson, Margaret ; Parr, Michael ; Williamson, Margaret ; Hillman, Ken. / Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study. In: Joint Commission Journal on Quality and Patient Safety. 2018 ; Vol. 44, No. 9. pp. 505-513.
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Cardona, M, Turner, RM, Chapman, A, Alkhouri, H, Lewis, ET, Jan, S, Nicholson, M, Parr, M, Williamson, M & Hillman, K 2018, 'Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study' Joint Commission Journal on Quality and Patient Safety, vol. 44, no. 9, pp. 505-513. https://doi.org/10.1016/j.jcjq.2018.04.001

Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study. / Cardona, Magnolia; Turner, Robin M.; Chapman, Amanda; Alkhouri, Hatem; Lewis, Ebony T.; Jan, Stephen; Nicholson, Margaret; Parr, Michael; Williamson, Margaret; Hillman, Ken.

In: Joint Commission Journal on Quality and Patient Safety, Vol. 44, No. 9, 01.09.2018, p. 505-513.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study

AU - Cardona, Magnolia

AU - Turner, Robin M.

AU - Chapman, Amanda

AU - Alkhouri, Hatem

AU - Lewis, Ebony T.

AU - Jan, Stephen

AU - Nicholson, Margaret

AU - Parr, Michael

AU - Williamson, Margaret

AU - Hillman, Ken

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N2 - Background: Many patients near the end of life are subject to rapid response system (RRS) calls. A study was conducted in a large Sydney teaching hospital to identify a cutoff point that defines nonbeneficial treatment for older hospital patients receiving an RRS call, describe interventions administered, and measure the cost of hospitalization. Methods: This was a retrospective cohort of 733 adult inpatients with data for the period three months before and after their last placed RRS call. Subgroup analysis of patients aged ≥ 80 years was conducted. Log-rank, chi-square, and t-tests were used to compare survival, and logistic regression was used to examine predictors of death. Results: Overall, 65 (8.9%) patients had a preexisting not-for-resuscitation (NFR) or not-for-RRS order; none of those patients survived to three months. By contrast, patients without an NFR or not-for-RRS order had three-month survival probability of 71% (log-rank χ2 145.63; p < 0.001). 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 the very old transferred to the ICU was higher than for those not requiring treatment in the ICU (US$33,990 vs. US$14,774; p = 0.045). Conclusion: 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.

AB - Background: Many patients near the end of life are subject to rapid response system (RRS) calls. A study was conducted in a large Sydney teaching hospital to identify a cutoff point that defines nonbeneficial treatment for older hospital patients receiving an RRS call, describe interventions administered, and measure the cost of hospitalization. Methods: This was a retrospective cohort of 733 adult inpatients with data for the period three months before and after their last placed RRS call. Subgroup analysis of patients aged ≥ 80 years was conducted. Log-rank, chi-square, and t-tests were used to compare survival, and logistic regression was used to examine predictors of death. Results: Overall, 65 (8.9%) patients had a preexisting not-for-resuscitation (NFR) or not-for-RRS order; none of those patients survived to three months. By contrast, patients without an NFR or not-for-RRS order had three-month survival probability of 71% (log-rank χ2 145.63; p < 0.001). 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 the very old transferred to the ICU was higher than for those not requiring treatment in the ICU (US$33,990 vs. US$14,774; p = 0.045). Conclusion: 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.

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