Do ICU Admissions Following Rapid Response Events Differ by Patient Demographics?

Abstract

Background

Rapid response systems (RRS) have been developed to identify and manage clinical deterioration on hospital floors. However, disparities in downstream care decisions, particularly ICU triage, remain poorly understood. This study investigated the role of demographic variables in ICU admission decisions following rapid response activation.

Methods

We conducted a retrospective analysis of 37,400 RRS activations at a tertiary academic medical center (2013-2023). Data included demographics, primary service at time of trigger trigger reasons, and code status. The RRS comprises an ICU nurse, respiratory therapist, and on-call ICU physician; however, the attending physician of record determines final disposition. Multivariable logistic regression estimated odds of ICU transfer, adjusted for age, sex, marital status, race, ethnicity, primary service, code status, and trigger reason; 95% CIs are reported.

Results

Of 13,799 patients, 1126 (8.2%) were transferred to the ICU after a trigger. Female sex was associated with 13.5% lower odds of ICU admission (OR 0.865; p < 0.05), and married status was associated with 18.6% higher odds of admission (OR 1.186; p < 0.05). Race and age were not significantly associated with ICU transfer. Interaction terms between race and activation reason were nonsignificant.

Conclusion

Despite similar clinical criteria for activation, female patients were less likely to be transferred to the ICU than male patients following a rapid response activation. This suggests a potential difference in acute care decision-making. Further research using a combination of prospective and mixed methods approaches would be beneficial to examine how healthcare providers make decisions and to explore strategies to reduce potential unintentional influences.