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. 2013 Apr-Jun;25(2):99-105.
doi: 10.5935/0103-507X.20130020.

The performance of a rapid response team in the management of code yellow events at a university hospital

[Article in English, Portuguese]
Priscila da Silva Taguti  1 , Adriana Zanoni Dotti, Karinne Peres de Araujo, Paula Silva de Pariz, Gustavo Ferreira Dias, Ivanil Aparecida Moro Kauss, Cintia Magalhães Carvalho Grion, Lucienne Tibery Queiroz Cardoso
Affiliations

The performance of a rapid response team in the management of code yellow events at a university hospital

[Article in English, Portuguese]
Priscila da Silva Taguti et al. Rev Bras Ter Intensiva. 2013 Apr-Jun.

Abstract
in English, Portuguese

Objective: To describe the epidemiological data of the clinical instability events in patients attended to by the rapid response team and to identify prognostic factors.

Methods: This was a longitudinal study, performed from January to July 2010, with an adult inpatient population in a hospital environment. The data collected regarding the code yellow service included the criteria of the clinical instability, the drug and non-drug therapies administered and the activities and procedures performed. The outcomes evaluated were the need for intensive care unit admission and the hospital mortality rates. A level of p=0.05 was considered to be significant.

Results: A total of 150 code yellow events that occurred in 104 patients were evaluated. The most common causes were related to acute respiratory insufficiency with hypoxia or a change in the respiratory rate and a concern of the team about the patient's clinical condition. It was necessary to request a transfer to the intensive care unit in 80 of the 150 cases (53.3%). It was necessary to perform 42 procedures. The most frequent procedures were orotracheal intubation and the insertion of a central venous catheter. The patients who were in critical condition and had to wait for an intensive care unit bed had a higher risk of death compared to the other patients (hazard ratio: 3.12; 95% CI: 1.80-5.40; p<0.001).

Conclusions: There are patients in critical condition that require expert intensive care in the regular ward unit hospital beds. The events that most frequently led to the code yellow activation were related to hemodynamic and respiratory support. The interventions performed indicate the need for a physician on the team. The situation of pent-up demand is associated with a higher mortality rate.

Objetivo: Descrever dados epidemiológicos de eventos de instabilidade clínica em pacientes atendidos pelo time de resposta rápida e identificar fatores prognósticos.

Métodos: Estudo longitudinal, realizado de janeiro a junho de 2010, com população adulta internada em ambiente hospitalar. Os dados coletados sobre o atendimento do código amarelo foram critérios de instabilidade clínica, terapia medicamentosa e não medicamentosa, orientações e procedimentos. Os desfechos avaliados foram necessidade de admissão em unidade de terapia intensiva e mortalidade hospitalar. O nível de significância utilizado foi de p=0,05.

Resultados: Foram avaliados 150 códigos amarelos que ocorreram com 104 pacientes. Os motivos mais frequentes estiveram relacionados à insuficiência respiratória aguda, apresentando hipóxia ou alteração da frequência respiratória, e preocupação da equipe com o estado clínico do paciente. Houve necessidade de solicitação de transferência para unidade de terapia intensiva em 80/150 (53,3%) ocasiões. Foi necessária a realização de 42 procedimentos, sendo os mais frequentes a intubação orotraqueal e a inserção de cateter venoso central. Os pacientes graves que aguardavam leito de unidade de terapia intensiva apresentaram maior chance de morte, comparados aos demais pacientes (hazard ratio: 3,12; IC95%: 1,80-5,40; p<0,001).

Conclusão: Existem pacientes graves que necessitam de tratamento intensivo especializado nos leitos comuns de enfermarias dos hospitais. Os eventos que mais levaram ao acionamento do código amarelo estiveram relacionados a suporte respiratório e hemodinâmico. As intervenções realizadas caracterizam a necessidade do médico na equipe. A situação de demanda reprimida está associada à maior mortalidade.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Survival analysis comparing code yellow patients in a scenario of pentup demand with other patients. PD - pent-up demand; log-rank test: p<0.001.
See this image and copyright information in PMC

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