Abstract Or104: The Benefits of Proactive Versus Reactive Rapid Response Activations

Abstract

Introduction: Delays in ICU transfer are associated with increased hospital mortality. Rapid response systems are designed to identify and manage clinical deterioration earlier, and their use has been associated with decreased cardiac arrest and hospital mortality. While all of these systems have a reactive component of responding when called, less is known about the added benefit of proactive activations. Goal/Aim: To quantify the added impact of proactive rounding by a rapid response team. Methods: We conducted a retrospective analysis of prospectively collected, consecutive rapid response logs at a single hospital between January 2022 and December 2024, extracting the trigger, any interventions administered and the outcome of the RRT call. During the study period, RRT activations were led by a dedicated critical care nurse, with a respiratory therapist and intensivist available for backup, and an AI early warning score (eCART, AgileMD) was visible to nurses and providers in the electronic health record (Cerner, Oracle Health). Activations were categorized as reactive if they were triggered by a call from the floor and proactive if initiated by the RRT nurse in response to an elevated eCART score. Results: A total of 16,589 RRT activations were analyzed (a rate of 350 activations per 1,000 adult admissions) during the study period. Of those, 10,157 (61%) activations were deemed reactive and 6,432 (39%) were deemed proactive. Interventions most commonly included diagnostics (e.g., labs and imaging), IV fluid administration, medications (e.g., diuretics and antiarrhythmics), goals of care discussions and transfer to a higher level of care (e.g., ICU or stepdown unit). Interventions were required for 7,626 (75%) of reactive events and 1,865 (18%) required transfer to a higher level of care. In contrast, 1,034 (16%) of proactive events required any intervention and 178 (3%) of this subset required escalation to a higher level of care. The types of interventions were similar between reactive and proactive activations. Conclusions: Our RRT team saw an average of 6 additional patients per day proactively, which resulted in approximately 1 patient per day receiving intervention for clinical deterioration that would otherwise have been delayed or missed entirely.