Survival distribution outcomes of delayed rapid response team activation among nurses in Hangzhou tertiary hospitals, China

Rapid Response Team (RRT) has been widely adopted in many hospitals to detect and take adequate measures to reduce cardiac arrest and in-hospital mortality before a patient's condition deteriorates. Failure or delay in RRT activation has been associated with adverse patient outcomes. However, limited research has examined RRT delay and its associated factors in China, particularly concerning the knowledge, attitudes and compliance of nurses regarding RRT. This study aimed to investigate the factors associated with survival distribution of admission to RRT delays and their impact on patient outcomes, as well as to assess the factors associated with knowledge, attitudes, and compliance of general ward nurses in tertiary hospitals in Hangzhou, China. This study consisted of two phases. Phase one involved a retrospective analysis of RRT activation data from 636 patients to identify factors associated with survival distribution of admission to RRT delay and the impacts of delayed RRT activation on patient outcomes by multivariable Cox regression analysis. In Phase two, a self-administered online questionnaire was distributed to 779 nurses to assess their knowledge, attitudes, and compliance regarding RRT using multiple regression analysis. In Phase one, 18.4% (117/636) were considered RRT delay, with a median (interquartile range) of 8.5 (12) days from admission to RRT activation. Six significant factors were associated with the hazard ratio of admission to RRT delay including RRT call time, admission source, modified early warning score (MEWS), infection, lung infection and respiratory failure/ acute respiratory distress syndrome(ARDS). However, no statistically significant association was found between RRT delay and patient outcomes. In Phase two, the mean knowledge score among nurses was 3.59 ± 1.30 (out of 6), and the mean attitude score was 51.00 ± 6.05 (out of 65), with 27.1% of nurses demonstrating good compliance with RRT protocols. RRT knowledge was associated with age, work experience and calling RRT at least once, while RRT attitude was associated with the type of hospital, gender, work experience, agreement with RRT criteria, RRT knowledge, unit culture and team characteristics. RRT compliance was associated with RRT knowledge, agreement with criteria and RRT training(p<0.05). These findings highlight the need for targeted interventions to improve RRT-related knowledge, attitudes, and compliance. Hospital leadership should consider adjusting staffing levels, particularly during night shifts, to ensure adequate human resources, and nurses should focus more attention on high-risk patients, such as those with elevated MEWS scores, infections, or respiratory failure/ARDS, to reduce RRT delays. Additionally, an effective and comprehensive RRT training program is necessary to improve nurses’ ability to recognize and respond to early signs of patient deterioration. Improving these aspects is crucial for enhancing overall patient outcomes and reducing RRT delay, ultimately saving more lives.

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