Rapid response team: the early identification of septic patients

Background

Rapid response teams (RRTs) represent an intuitively simple concept: when a patient demonstrates signs of imminent clinical deterioration, a team of providers is summoned to the bedside to immediately assess and treat the patient with the goal of preventing ICU transfer, cardiac arrest, or death [1]. Patients whose condition deteriorates acutely while hospitalized often exhibit warning signs (such as abnormal vital signs) in the hours before experiencing adverse clinical outcomes. Sepsis is an illness in which the body has a severe response to bacteria or other germs. This response may be called systemic inflammatory response syndrome (SIRS) [2]. The criteria for calling the RRT are the same as/similar to symptoms of sepsis. We aimed to describe the various criteria for calling the RRT for patients who developed sepsis, initial treatment before transfer to the ICU or step-down unit and outcomes.

Materials and methods

This retrospective study was conducted in 2012 in the ICU of Hospital Israelita Albert Einstein, a general, private tertiary hospital. During the study period, the hospital had 614 beds, 6.7% (41/614) of which were in the ICU and 13.5% (83/614) were the step-down unit. We included patients 18 years of age or older diagnosed with severe sepsis and septic shock treated by the RRT and transferred to the ICU or step-down unit for study retrospectively. We excluded patients who had contraindications to cardiac resuscitation. Severe sepsis and septic shock were defined according to the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions [3]. Data regarding age, gender, Simplified Acute Physiology Score II (SAPS II) [4], presence of the following comorbidities, criteria for calling the RRT, initial treatment for sepsis, length of ICU and total stay, and patient outcome were recorded.

Results

Sixty-five of 41 (63.1%) were males, 23 (35.4%) were transferred to the step-down unit and 42 (64.6%) were transferred to ICU. Their age was 64.7 ± 17.8 years. SAPS II score was 57.8 ± 12.8, length of stay was median 26 days, ICU stay was median 3 days. The treatment of sepsis was also initiated in the ward. The serum lactate + measured blood culture was 40 (63.5%) and fluid administration was 41 (64.1%) (Table 1). Pressing the RRT was in 43 (66.2%) cases by the staff member with significant concern about the patient's condition, 27 (41.5%) cases by changes in systolic blood pressure, and 23 (35.4%) cases due to change in oxygen saturation (Table 2).

Table 1

Table 2

Conclusions

The criteria for calling the RRT can support the prompt identification of patients who have sepsis and prevent disease progression. Furthermore, the treatment may also be performed in the ward and may result in a reduction in mortality.