Registrar triage, communication and moral distress during end-of-life care rapid response team calls in a teaching hospital

BACKGROUND Approximately one third of Rapid Response Teams (RRT) involve end of life care (EOLC) issues. Intensive care unit (ICU) registrar experience in such calls is under-investigated. AIM To evaluate the proportion of RRT calls triaged as relating to EOLC issues, issues around communication regarding prognostication, registrar self-reported moral distress, and associations between RRT EOLC classification and patient outcomes. METHODS Prospective observational study of RRT calls in a tertiary referrals hospital between December 2016 and January 2017 using a standardised case report form and data from an electronic RRT database. RESULTS There were 401 RRT calls in the study period, and data were available for 270 calls (67%), of which 72%, 10%, and 18% were triaged as "obviously not EOLC call", "obvious EOLC call", and "uncertain EOLC call", respectively. Most discussions regarding prognostication occurred between registrars, and more than half were with a covering doctor (55%). Consensus on prognostication was achieved in 93% cases. Registrars reported distress in 19% of calls that obviously related to EOLC and 22% of calls that were uncertain, compared to