Jeff Jensen

958: DATA UTILIZATION DURING INTERHOSPITAL TRANSFERS OF CARE FOR CRITICALLY ILL PATIENTS

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) of ICU patients requiring large volume MTPs. Methods: The MTP activations in the ICUs at our facility were retrospectively reviewed, with a detailed analysis of ICU patients who received greater than 30 units of red blood cells (RBCs). Clinicians activate the MTP in anticipation of massive transfusion resulting in the preparation of ongoing sets of 4 RBC, 4 plasma, and 1 apheresis platelet units. Results: A total of 360 MTP activations occurred from 4/2009-6/2015, including 221 initiated in the ICU. Six patients (4 males, 2 females) received greater than 30 RBC units. The leading diagnoses for the patients were end stage liver disease (2), aneurysm repair (2), and liver transplant (2). The mean number of units issued was RBC 40.7 (range 36–48), plasma 40.0 (36–38), platelet 10.7 (6–13), and cryoprecipitate pools 2.8 (0–6). Immediately prior to and during the MTPs, laboratory values [mean (range)] were as follows: hemoglobin minimum(min) 5.8 g/dL (3.9–7.4), maximum (max) 12.8 g/dL (11.2–16.7), mean 9.4 g/dL (7.9–12.2); platelet count min 31x109/L (5–42), max 142 x109/L (88–312), mean 77 x109/L (39–161); PTT min 40 seconds (30–50), max 124 seconds (47–235), mean 63 seconds (35–90); INR min 1.12 (0.69–2.15), max 3.39 (1.33–5.65), mean 1.86 (1.13–2.73); and fibrinogen activity min 108 g/dL (71–193), max 316 g/dL (175–550), mean 190 g/dL (132–236). All patients were intubated and required full ventilator support. The 30-day in-hospital survival was 33% in this patient group. Conclusions: ICU patients requiring greater than 30 RBC units during MTP activation have variable laboratory results and high morbidity and mortality. An institutional policy now requires communication between the Transfusion Medicine and ICU faculty members when 40 RBC units are issued to optimize ongoing care of the patient.

794: IMPROVING PRIMARY TEAM PRESENCE AND PARTICIPATION DURING RAPID RESPONSE TEAM ACTIVATIONS

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233: OUTCOMES OF DELAYED RRT ACTIVATION IN PATIENTS TRANSFERRING TO THE ICU

Learning Objectives: The Rapid Response Team (RRT) was designed to reduce serious adverse events such as cardiac arrest on the floor by activating a “critical care team” to the bedside of the deteriorating patient. To date there has been mixed evidence about the effectiveness of rapid response teams in decreasing patient mortality and in reducing adverse outcomes. To be most effective, the RRT should be activated early in the course of physiological deterioration. This study examines the effect of delay on RRT activation on hospital mortality and morbidity. It was hypothesized that delay in RRT activation would result in worse patient outcomes. Methods: A retrospective cohort study of all the Rapid Response Team (RRT) activations taking place between January 2012 and December 2012 was performed in a tertiary academic center. The subjects were patients admitted to the ICU following a RRT activation. Data was compared between those patients who had a timely RRT activation (60 minutes), after adjustment for patient characteristics using multivariate Cox proportional regression analysis. The primary outcome was 30-Day mortality after RRT activation. The secondary outcomes were hospital and ICU length of stay, mechanical ventilator and vasopressor use in ICU. Results: Of 1120 patients who required ICU admission after RRT call, 698 (62%) had >60 minute delay in RRT activation. Patients who experienced delay in RRT activation after meeting physiologic RRT criteria had increased mortality (adjusted hazard ratio 1.5 (95% 1.05-2.2): p=0.02. Mortality was positively correlated with increased time in hours from first abnormal vital sign to RRT activation (adjusted Hazards Ratio 1.03) (95% 1.01-1.04): p=0.001. Patients with delayed activation had increased ICU length of stay, p=0.004, increased ventilator use, p= 0.04 and vasopressor use, p < 0.001. Conclusions:Delayed RRT activation occurred frequently and was independently associated with increased mortality and ICU resource utilization.

501: The Impact of the Primary Team presence during Rapid Response Team Activation

Introduction: The optimal role of the primary service in Rapid Response Team (RRT) has not been well studied. We previously evaluated the impact of primary service presence on RRT activations in a retrospective review, finding their presence to positively correlate with transfers to higher levels of