Resuscitation 84 (2013) 1339–1344 Contents lists available at ScienceDirect Resuscitation jo ur nal homep age: www.elsevier.com/locate/resuscitation Clinical paper Changes in end of life care 5 years after the introduction of a rapid response team: A multicentre retrospective study  James Downar a,b,* , Reeta Barua c , Danielle Rodin d , Brandon Lejnieks c , Rakesh Gudimella e , Victoria McCredie f , Chris Hayes g,b , Andrew Steel h,i a Critical Care and Palliative Care, University Health Network, Toronto, Canada b Department of Medicine, University of Toronto, Toronto, Canada c Queen’s University, Kingston, Canada d University of Toronto, Toronto, Canada e McMaster University, Hamilton, Canada f Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada g Critical Care, St. Michael’s Hospital, Toronto, Canada h Critical Care and Anaesthesiology, University Health Network, Toronto, Canada i Department of Anaesthesiology, University of Toronto, Toronto, Canada a r t i c l e i n f o Article history: Received 16 October 2012 Received in revised form 17 February 2013 Accepted 5 March 2013 Keywords: Critical care Terminal care Resuscitation orders Withholding treatment Hospital rapid response team Palliative care a b s t r a c t Rationale: Rapid response teams (RRTs) are intended to stabilize deteriorating patients on the ward, but recent studies suggest that RRTs may also improve end-of-life care (EOLC). We sought to study the effect of introducing an RRT on EOLC at our institutions, and compare the EOLC care received by patients who were consulted by the RRT with that of patients who were not consulted by the RRT. Methods: Retrospective review of 450 consecutive deaths at 3 institutions. We compared demographic factors and EOLC received before (2005) and 5 years after (2010) the introduction of an RRT. We also compared these same factors for patients who died in 2010 with and without RRT consultation. Results: There were no differences in the proportion of patients who had Patient/Family Conferences or orders to limit life support on the ward between 2005 and 2010. Although the RRT was consulted for 30% of patients eligible to be seen by the RRT, the RRT was involved in only 11.1% of Patient/Family Conferences that took place on the ward. The prevalence of palliative care consultation and orders for opioids as needed was higher in 2010 than 2005, but those seen by the RRT were less likely to receive a palliative care consultation (30.2% vs. 55.9%), spiritual care consultation (25.4% vs. 41.3%) or an order for sedatives as needed (44.4% vs. 65.0%) than those who were not seen by the RRT. There was no change in the proportion of patients admitted to the ICU in 2010 compared with 2005, and multivariable logistic regression showed that the year of death did not influence the likelihood of ICU admission based on any comorbid or demographic factors. Conclusions: The introduction of an RRT was not associated with significant improvements in EOLC at our institutions. However, almost 1/3 of dying patients were consulted by the RRT, suggesting that the RRT could play a role in facilitating improved EOLC for some inpatients. © 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Critical care rapid response teams (RRTs) were originally cre- ated to provide timely interventions to improve the medical status Abbreviations: RRT, rapid response team; EOLC, end of life care; PRN, pro re nata (as needed); PC, palliative care; SC, spiritual care; DNR, “do not resuscitate”; WHLS, withhold life support; WDLS, withdraw life support.  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.03.003. * Corresponding author at: 200 Elizabeth St. 9N-926, Toronto, Canada, M5G 2C4. E-mail address: James.downar@utoronto.ca (J. Downar). of acutely ill patients on the ward, thereby improving morbidity and mortality. 1,2 Although RRTs may not be effective for improving mortality and reducing cardiac arrests, 3,4 they may play an impor- tant role in communicating with patients and family members about goals of care and resuscitation orders. Recent studies even suggest that RRTs have a beneficial effect on end-of-life care (EOLC) by increasing the use of comfort medications and chaplaincy. 5,6 Hospitals in Ontario, Canada began using RRTs in 2005 follow- ing a mandate from the Ministry of Health and Long-Term Care. The mandate included a provision for RRTs to improve EOLC by mitigating “avoidable, or inappropriate ICU admissions”. 7 In order to learn more about the effectiveness of RRTs for improving EOLC and communication with patients and family members in our own 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.03.003