Rapid response team trigger modifications: are we using them safely?

Background Rapid response teams (RRT) were first proposed as a means of reducing inpatient morbidity and mortality. Modifying RRT activation triggers poses a potential risk for delayed recognition of a deteriorating patient. Trigger modifications have not been validated for safety. Aims To determine if RRT trigger modifications are associated with: increased frequency of recurrent RRT activation; increased length of stay (LOS); increased intensive care admission; and increased in-hospital mortality. Methods A retrospective audit of all RRT activations occurring at the Launceston General Hospital (LGH) over an 18-month period was performed. Results Rate of recurrent RRT activations did not decrease with the use of trigger modifications around the time of RRT activation, and for patients with two modifications, the frequency increased (1.98 vs 1.32, P = 0.007). LGH LOS increased for patients with any trigger modifications compared to those with none (11 vs 9, P = 0.0002), and for patients with two modifications (11.5 vs 9, P = 0.010). Total hospital LOS increased for patients with any modifications compared to patients with none (12 vs 10, P = 0.002). There was no significant association between trigger modifications and frequency of intensive care unit admission. The relative risk of in-hospital death increased with increasing numbers of trigger modifications (relative risk 1.38-4.89). Conclusions Trigger modifications are associated with increased hospital LOS and increased rate of in-hospital death and do not reduce the number of recurrent events. For patients in whom escalation of care is not appropriate, the presence of multiple trigger modifications at the time of an RRT activation may be a useful trigger for conversations around goals of care.