A 5-year analysis of rapid response system activation at an in-hospital haemodialysis unit

Abstract

Objective: To study the incidence, patient and event characteristics, and outcome of rapid response system (RRS) activation on an in-hospital haemodialysis unit.

Design: Retrospective review of all RRS events on an in-hospital 10-bed haemodialysis unit over a 64-month period (November 2001 to February 2007).

Setting: University of Pittsburgh Medical Center Presbyterian Hospital, a 730-bed academic, urban, tertiary care adult hospital in the USA. Interventions None.

Results: Over a 64-month-period, 107 of 8928 patients undergoing haemodialysis on the dialysis unit required an RRS activation (12 events/1000 patients dialysed). The most common reasons for RRS activation were respiratory distress/hypoxaemia (27%) and mental status change (24%). Predictors of in-hospital mortality included old age (33% in-hospital mortality for patients aged 65 years or older vs 14% for patients aged less than 65 years; χ(2) = 5.66, df = 1, p = 0.017), and RRS activation due to a respiratory abnormality (37% mortality for respiratory codes vs 18% for all other codes; χ(2) = 4.12, df = 1, p = 0.042). Surprisingly, only 71% of the patients who had an RRS event had the event as dialysis was occurring. Twenty-four patients (22%) met one or more RRS activation criteria upon first vital sign check in the dialysis unit; RRS was activated on 12 (11%) of these patients before dialysis was started. Nineteen (18%) additional patients had an RRS event after their dialysis session had ended, while awaiting transport back to their unit.

Conclusions: From our findings, it can be suggested that critical events often occur before and after dialysis treatment, during or awaiting transport. Careful assessment of these high-risk patients before and after transport, to and from the dialysis unit may be warranted.