Characteristics and Dying Trajectories of Adult Hospital Patients from Acute Care Wards who Die following review by the Rapid Response Team

Abstract

A third of patients reviewed by rapid response teams (RRT) require end-of-life care. However, little is known about the characteristics and management of these patients following RRT review. This paper presents results of a retrospective, descriptive audit that explored the dying trajectory of adult ward inpatients who died outside of the intensive care unit following RRT review. The study setting was a 430-bed tertiary New Zealand hospital during 2013. RRT, inpatient databases and hospital notes were used to identify 100 consecutive adult inpatients who died subsequent to RRT review. Outcome measures included time from RRT review to death, place of death, pre-existing comorbidities and frequency of medical review. Results demonstrated that patients were old (median 77 years, IQR 63–85years), emergency admissions (n=100) and admitted under a medical specialty (n=71). All but one of the cohort had pre-existing comorbidities (mean 3.2, SD 1.7), almost a third (n=31) had cancer and 51% had 1–4 previous inpatient admissions within the previous 12 months. The mean length of stay prior to RRT review was 4.9 days (SD 5.5) during which patients were frequently reviewed by senior medical staff (mean 6.8 times, SD 6.9, range 0–44). Twenty percent of patients died after their first RRT review with a further 40% receiving treatment limitation/palliation. Fifty-two percent of patients had a pre-existing Do Not Attempt Resuscitation (DNAR) order. Eighty percent of patients died in hospital. Whilst the RRT fulfils an unmet need in decision-making at end of life, there is a need to understand what RRT, instead of ward-based or palliative care teams, offers dying patients.