Objective:

To evaluate delays in Rapid Response Team (RRT) assessments and subsequent diagnostic interventions, including brain imaging, EEG testing, and neurological consultations for acute neurological emergencies in hospitalized adults.

Background:

In most hospitals, after activating RRT for acute neurological deterioration, urgent neurological tests like brain imaging and EEG are often needed for immediate care. Despite prompt RRT response, delays in obtaining these tests and neurological consultations are common, potentially increasing morbidity and mortality.

Design/Methods:

We reviewed data from hospitalized patients who experienced a sudden neurological emergency for a Q2 2024 quality improvement project. Our analysis included demographics, hospitalization details, the nature of the emergency, and the timing of key actions, such as RRT arrival, brain imaging, EEG, and neurology consultation, and clinical patient deterioration during the delays.

Results:

We identified 509 RRT activations, with 27 adult patients receiving care for neurological deterioration. The cohort included 14 females and 13 males, comprising 13 White, 1 Hispanic, and 13 African American patients. Imaging delays ranged from 48 to 4,947 minutes (Mean = 100.7 minutes, Median = 41 minutes), while EEG delays ranged from 12 to 1,300 minutes (Mean = 1,291.3 minutes, Median = 527 minutes). Neurology consultations occurred the same day or the following day. Four patients experienced neurological deterioration, marked by progression to non-verbal status, increased somnolence, full aphasia, and decreased responsiveness to painful stimuli. Imaging abnormalities revealed mild hemorrhages and evolving infarcts. Abnormal EEG findings included diffuse, rhythmic, and asymmetric slowing, as well as lateralized epileptiform discharges and myoclonic discharges.

Conclusions:

Evidence indicates that up to 15% of patients may experience progressive neurological deterioration during delays in imaging, EEG studies, and evaluations after RRT assessments. Such delays heighten the risk of over- and under-treatment, underscoring the need for timely diagnostic processes. Further studies are required to validate these findings.