Rapid response teams, do not resuscitate orders, and potential opportunities to improve end-of-life care: a multicentre retrospective study

Abstract

Purpose: Rapid response teams (RRTs) were created to stabilize acutely ill patients on the ward, but recent studies suggest that RRTs may improve end-of-life care (EOLC). To learn more about the role of the RRT in EOLC at our institutions, we conducted a retrospective review.

Methods: Retrospective review of 300 RRT consultations at 3 academic hospitals in Toronto, Canada.

Results: The typical consultation was for an elderly patient with chronic illness. More than 90% had a "full resuscitation" order at the time of consultation. One third were admitted to the intensive care unit within 48 hours of the RRT consultation, and 24.7% ultimately died. Twenty-seven (9.3%) had a patient/family conference on the ward within 48h of the RRT consultation, 24 (8.3%) of whom changed their resuscitation order as a result. Among those who changed their resuscitation order, fewer than 20% were referred to the palliative care or spiritual care service, or prescribed comfort medications as needed (pro re nata), within 48 h of the RRT consultation; 2 patients died without receiving any common EOLC orders, and 15 (63%) died before discharge.

Conclusions: RRT consultation is an important milestone for many patients approaching EOL. RRTs frequently participate in EOL discussions and decision-making, but they may miss opportunities to facilitate EOLC.

Keywords: Critical care; Hospital rapid response team; Palliative care; Resuscitation orders; Terminal care; Withholding treatment.