End-of-life care decision-making by Rapid Response System teams for hospital inpatients; a systematic review

Laura Creighton, Deborah Coleman, Jennifer McGaughey

Research output: Contribution to conferencePosterpeer-review

Abstract

Background: Rapid Response System (RRS) teams were implemented to provide specialist critical care skills at the bedside for patients who deteriorated on acute hospital wards, in an effort to reduce Intensive Care admissions and deaths. This role has since evolved to include the decision-making and implementation of End-of-Life Care (EOLC). Despite becoming an expansion of the role there is limited structure or frameworks defining how EOLC decisions are made.
Aim: To determine the effectiveness of the role of RRS teams in EOLC decision-making.
Methods: We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases for qualitative, quantitative, and mixed-method studies using free text and MESH terms up to February 2020. All studies were screened for eligibility, data extracted and quality appraised using the Mixed Methods Appraisal Tool (MMAT) (Pluye et al, 2011). Ten percent of data extraction and quality assessment was undertaken by two independent reviewers. Data was analysed narratively.
Results: We included 15 non-randomised studies, 14 observational studies and 1 mixed-methods study. Findings showed RRS teams have an EOLC interaction with approximately a third of reviewed patients and RRS involvement resulted in better symptom management and planned EOLC, leading to a better quality of death. No studies provided a structured framework or decision-making model to understand how EOLC decisions were made by RRS teams. Studies concluded that RRS teams may not be the best resource for EOLC planning and suggest that timelier discussion with patients regarding limitations of care and the addition of a palliative care nurse to RRS teams could be effective.
Conclusion: EOLC decision-making is currently an integral role of RRS teams. Further research is required to ascertain how the decision-making process is undertaken and what structural framework is used. There is also a need to explore the use of a palliative care team with RRS teams.
Original languageEnglish
Publication statusPublished - 15 Sep 2020
EventBritish Association of Critical Care Nursing (BACCN) Annual Conference - Virtual
Duration: 14 Sep 202015 Sep 2020

Conference

ConferenceBritish Association of Critical Care Nursing (BACCN) Annual Conference
Abbreviated titleBACCN Annual Conference
Period14/09/202015/09/2020

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