(1252) Activating Rapid Response Teams by Clinical Decision Support Software Leads to Better Outcomes

Introduction: Hospitalized patients frequently experience unanticipated deterioration, leading to adverse clinical outcomes. Rapid Response Teams (RRTs) have become a standard of care to rescue these patients. RRTs’ activation criteria, traditionally, are deranged vital signs or “worry” by a provider. This may lead to wide variability in RRT activation practice and outcomes for RRT intervention. We hypothesized that RRT activation by a near real-time clinical decision support software, utilizing the national early warning score (NEWS), would improve clinical outcomes for patients experiencing decompensation on acute care wards.

Methods: Following IRB approval, RRT activation data on adult patients admitted to a large academic hospital's acute care floors between January 2018 and June 2023 were reviewed. RRT activations were divided into two groups: Group 1 - activations by the software and Group 2 – activations by traditional methods. The two groups were compared by patient demographics, cardiac arrests, ICU transfers, hospital and ICU length-of-stay (LOS), and in-hospital mortality.

Results: During the study period, 22,811 RRT activations on 12,270 patients were evaluated. The software initiated 3,757 (30.6%) activations. Group 1 was younger (62 vs. 64 years, p< 0.01), and had more white patients (64% vs. 57%, p< 0.05). There were fewer ICU transfers per 1000 patient days, relative to activations, in Group 1 vs Group 2 (15.7 vs 23.1, p< 0.01). The mortality risks for both ICU transfer and ICU non-transfer subgroups were lower in Group 1 (14% vs 18%, p=0.03, and 4.2% vs 6.7%, p< 0.01). Cardiac arrests per 1000 patient days were lower in Group 1 compared to Group 2 (1.4 vs. 3.6 p< 0.01). The median hospital LOS was higher in Group 1 for both ICU transfer (15.3 vs 12.3 days, p< 0.05) and ICU non-transfer patients (8.9 vs 8.2 days, p< 0.05).

Conclusions: RRT activation for acute deterioration of hospital floor patients, by near real-time clinical decision support software using NEWS criteria, compared to traditional activation criteria, was associated with less ICU transfers, less cardiac arrests, and better mortality, with modest increases in LOS. Utilization of clinical decision support software to activate RRT may augment the safety of patients on acute care wards.