(371) Rapid Response Team Activations: A Pivotal Moment for Addressing Goals of Care

Introduction: Rapid Response activations (RRT) provide a pivotal moment for re-evaluating the patient’s clinical status and overall prognosis. Our Critical Care Outreach Team (CCOT) responds to RRT activations and is equipped with critical care-trained advanced practice providers and physician intensivists. During RRT activations, CCOT providers routinely review a patient’s code status and identify if the aggressive medical management needed to address a patient’s acute clinical deterioration is consistent with the patient’s current goals of care. This process may include conversing with the patient, surrogate decision maker, and/or primary healthcare team, altering a patient’s code status, and/or identifying the patient’s goals of care (GOC).

Methods: The CCOT uses an Utstein-style template for capturing core metrics during RRT activations. We developed a tool to capture specific GOC-focused metrics for each RRT activation, including when a CCOT provider directly 1) addresses GOC during an RRT activation, 2) initiates any change in code status during the RRT activation, and 3) transitions a patient to comfort care measures without escalation to the ICU. We reviewed these data over 14 months between May 1st, 2023, and June 30th, 2024.

Results: During the study period, we identified 152 RRT activations where the CCOT provider directly reviewed the patient’s GOC with the patient, surrogate decision maker, and/or primary healthcare team. Of the 152 RRT activations where the CCOT provider directly addressed the code status and GOC, the patient’s code status was updated or changed to DNR/DNI in 40 (26.3%) patients, and 39 patients (25.6%) were transitioned to comfort/end-of-life care without escalation to the ICU.

Conclusions: During a RRT activation, CCOT providers frequently manage adult patients with clinical deterioration. During these crucial moments, CCOT providers frequently review and clarify a patient's GOC. In this small retrospective analysis, when CCOT providers identified a change in clinical trajectory and directly addressed a patient’s GOC, one out of every four patients had a change in their code status. In these RRT activations, care management was recentered to provide compassionate care outside of the ICU rather than aggressive resuscitative efforts.