{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:12:16Z","timestamp":1777590736577,"version":"3.51.4"},"reference-count":59,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,1]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives\u2003<\/jats:title>\n                  <jats:list list-type=\"order\">\n                     <jats:list-item>\n                        <jats:p>To describe the associations between Rapid Response Team (RRT) patient review and other predefined clinical management actions, with risk of in-hospital cardiac arrest and in-hospital mortality in the first unplanned admission (UPA) to the adult intensive care unit (ICU) from the ward environment for each patient.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>To describe a novel RRT assessment tool for ward-based care for patients who were deteriorating.<\/jats:p>\n                     <\/jats:list-item>\n                  <\/jats:list>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A retrospective cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>A large multispecialty, tertiary referral and teaching hospital in England, UK.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>The study included 3175 consecutive adult ICU UPAs from hospital wards over a 6-year period (2014\u20132019).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>Ward-based management of deterioration prior to ICU admission was assessed by the RRT, using a scored checklist\u2014the UPA score. Admissions were compared in two groups according to their exposure to an RRT review in the 72 hours before ICU admission. Associations with in-hospital cardiac arrest within 24 hours before ICU admission and all-cause in-hospital mortality were estimated, using unadjusted and adjusted odds ratios (aORs) with 95%CI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>RRT review occurred in 1413 (44.5%) admissions and was associated with reduced odds of in-hospital cardiac arrest (aOR 0.51; 95%\u2009CI 0.36 to 0.78; p&lt;0.001), but similar odds of in-hospital mortality (OR 0.97; 95%\u2009CI 0.83 to 1.12; p=0.65). The median (IQR) UPA score was 1 (0 to 2), and each point increase was associated with increased odds of in-hospital cardiac arrest (aOR 1.13; 95%\u2009CI 1.06 to 1.23; p&lt;0.001) and in-hospital mortality (aOR 1.10; 95%\u2009CI 1.05 to 1.15; p&lt;0.001). Among individual UPA score items, Nursing Escalation Failure, Blood Gas Omission and Laboratory Blood Omission were associated with increased odds of in-hospital cardiac arrest, whereas Delayed Vital Signs and Failure to Recognise Deterioration were associated with increased odds of in-hospital mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions and relevance<\/jats:title>\n                  <jats:p>An RRT review in the 72 hours prior to ICU admission was associated with reduced odds of in-hospital cardiac arrest but did not impact in-hospital mortality. Higher UPA scores were associated with increased incidence of both in-hospital cardiac arrest and in-hospital mortality. In addition, this study describes a novel and adaptable RRT scoring tool (the UPA score) for safety monitoring and quality improvement.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102016","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T09:02:00Z","timestamp":1758877320000},"page":"e102016","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Rapid response teams and recommended ward-based management of acute deterioration: a single-centre retrospective cohort study in an inner-city London (UK) teaching hospital"],"prefix":"10.1136","volume":"15","author":[{"given":"Sophie","family":"Hadfield","sequence":"first","affiliation":[{"name":"Department of Critical Care, King\u2019s College Hospital NHS Foundation Trust, London, 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