Background: The outcomes of rapid response systems (RRS) are poorly established in older people. We examined the outcomes in older inpatients at a tertiary hospital that uses a 2-tier RRS, including the outcomes of each tier.
Methods: The 2-tier RRS comprised the clinical review call (CRC) (tier one) and the medical emergency team call (MET) (tier two). We compared outcomes in four configurations of MET and CRC (MET with CRC; MET without CRC; CRC without MET; neither MET nor CRC).
Results: Amongst 3,910 consecutive admissions (mean age 84 years), there were 433 METs, 1395 CRCs. The occurrence of a CRC did not influence the association between MET and death. The rates of death for MET ± CRC was 30.5%, and 18.5% for CRC without MET. Compared to those without MET/CRC, on adjusted analysis, odds of death were increased both for patients having one or more METs ± CRC (adjusted odds ratio [aOR] 4.04, 95% confidence interval [CI] 2.96–5.52), and those having one or more CRCs without MET (aOR 2.22, 95% CI 1.68–2.93). Patients who required a MET ± CRC were more likely to be placed in a high-care residential facility (aOR 1.52, 95% CI 1.03–2.24), as were patients who required a CRC without MET (aOR 1.61, 95% CI 1.22–2.14).
Conclusions: Both METs and CRCs were associated with increased likelihood of death and new residential facility placement. These findings may better inform patient prognostication, discussions on goals of care, and discharge planning.