• Internal medicine journal · Dec 2022

    Observational Study

    Registrar Triage, Communication and Moral Distress during End of Life Care Rapid Response Team Calls in a Teaching Hospital.

    • Sadie Callahan, Juli Moran, Emily See, Daryl Jones, Glenn M Eastwood, Stephen Warrillow, and Austin RRT EOLC investigators.
    • Department of Intensive Care, Austin Hospital, Studley Road, Heidelberg, Victoria, Australia.
    • Intern Med J. 2022 Dec 1; 52 (12): 211621232116-2123.

    BackgroundApproximately one-third of rapid response teams (RRT) involve end-of-life care (EOLC) issues. Intensive care unit (ICU) registrar experience in such calls is underinvestigated.AimsTo evaluate the proportion of RRT calls triaged as relating to EOLC issues, issues around communication regarding prognostication, registrar self-reported moral distress and associations between RRT EOLC classification and patient outcomes.MethodsProspective observational study of RRT calls in a tertiary referrals hospital between December 2016 and January 2017 using a standardised case report form and data from an electronic RRT database.ResultsThere were 401 RRT calls in the study period, and data were available for 270 (67%) calls, of which 72%, 10% and 18% were triaged as 'obviously not EOLC call', 'obvious EOLC call' and 'uncertain EOLC call' respectively. Most discussions regarding prognostication occurred between registrars, and more than half (55%) were with a covering doctor. Consensus on prognostication was achieved in 93% cases. Registrars reported distress in 19% of calls that obviously related to EOLC and 22% of calls that were uncertain, compared with <1% of calls that were obviously not relating to EOLC. Inhospital mortality was 6%, 67% and 39% for obviously not EOLC, obvious EOLC and uncertain EOLC calls respectively.ConclusionsEOLC issues occur commonly in RRT calls and are often associated with moral distress to ICU registrars. Although consensus on prognostication is usually achieved, conversations often involve covering doctors. These issues impact on the ICU registrar experience of RRT calls and require further exploration.© 2021 Royal Australasian College of Physicians.

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