Analysis of Rapid Response Team calls within the Orthopaedic Department in a Queensland based Public Metro Hospital and Health Service: A retrospective cohort study

Dr Alison McCarthy: Principal Investigator: Design and conduct the study; Dr. Bryan Dai: Co Investigator: Design and conduct the study; Dr Kanika Jain: Co Investigator: Conduct and Oversee the Progress of the study; Mrs Cheryl Power: Data Custodian: Help with data acquisition; Dr Kate Campbell: Supervisor: Oversee project.

AIM: The purpose of this study is to review the RRT activations within the Orthopaedic Department in a Queensland based Public Metro hospital and health service during the time-period January 2018 - December 2020.

BACKGROUND: Medical Emergency Teams (MET) or Rapid Response Teams (RRT) are multidisciplinary teams of medical and nursing staff responsible for the evaluation and treatment of clinically deteriorating patients on the ward. Limited research has been done on the epidemiology of RRT calls that show risk factors such as increasing age at time of surgery, and certain co-morbidities such as a cardiac history or respiratory failure are associated with an increased risk of receiving a RRT call. There is a lack of research in the epidemiology of RRT calls for patients receiving a major orthopaedic procedure. Hence, we plan to identify the peri-operative variables contributing to MET calls in our orthopaedic patients. Knowing some of these peri-operative factors are preventable and modifiable, we hope to reduce the number of RRT calls being made in order to reduce patient mortality and reduce the use of the valuable hospital resources.

STUDY DESIGN: The study is designed as single-centre study to be conducted at the Orthopaedic department at The Princess Alexandra Hospital in Brisbane. The study population will include the patients who presented to the Orthopaedic department at The Princess Alexandra Hospital between the year January 2018 to December 2020 and had a RRT called during the admission. Statistical analyses will be conducted using SPSS (SPSS Inc., Chicago, IL, USA) or Stata (StataCorp, College Station, TX, USA).

SIGNIFICANCE: Understanding the possible contributing factors that led to the initiation of the RRT may lead to the consideration of change of care or practice perioperatively that could eventually decrease the number of RRT calls made within the Orthopaedic department.

PRELIMINARY RESULTS: Current findings show multiple parameters correlating to an increased risk of having a RRT call for a patient. Theseinclude known parameters such as increasing age at time of surgery and co-morbidities such as cardiac and respiratory compromise in patients. Estimates from the current data extraction also show emergent presentations compared to elective presentations as well as lower limb injuries are more likely to result in RRT calls. Peri-operative variables such as ASA status, intraoperative pharmacology, duration of surgery and time to surgery from presentation seem to have an impact on frequency of RRT calls. These parameters will require an amount of in-depth statistical analysis to confirm initial estimates. Further extraction of related factors/parameters may also be required if statistical analysis shows an unexpected correlation to one of the parameters being collected. This funding will enable us to invest into carrying out the in-depth analysis that is needed in understanding the critical co-relations surrounding the RRT calls.

Bibliography:
1) Lee A, Bishop G, Hillman K, Daffurn K. The Medical Emergency Team. Anaesthesia and Intensive Care.
1995;23(2):183-186.
2) Buist M, Harrison J, Abaloz E, Dyke S. Six year audit of cardiac arrests and medical emergency team calls in an
Australian outer metropolitan teaching hospital. BMJ. 2007;335(7631):1210-1212.
3) Tobin A, Santamaria J. Medical emergency teams are associated with reduced mortality across a major
metropolitan health network after two years service: a retrospective study using government administrative
data. Critical Care. 2012;16(5):R210.
4) Buist M. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected
cardiac arrests in hospital: preliminary study. BMJ. 2002;324(7334):387-390.
5) Calzavacca P, Licari E, Tee A, Mercer I, Haase M, Haase-Fielitz A et al. Features and outcome of patients
receiving multiple Medical Emergency Team reviews. Resuscitation. 2010;81(11):1509-1515.
6) Basilico F, Sweeney G, Losina E, Gaydos J, Skoniecki D, Wright E et al. Risk factors for cardiovascular
complications following total joint replacement surgery. Arthritis & Rheumatism. 2008;58(7):1915-1920.
7) Le Guen M, Tobin A. Epidemiology of in-hospital mortality in acute patients admitted to a tertiary-level
hospital. Internal Medicine Journal. 2016;46(4):457-464.