Rapid Response Teams Improve Outcomes for Critical Care Patients

When the Institute for Healthcare Improvements launched its 100,000 Lives campaign, one aspect included the establishment of Rapid Response Teams (RRTs). Most local hospitals have established these teams, and the results show “significant and sustained benefits,” according to an evaluation by Brookwood Medical Center. The benefits are so clear that the Joint Commission is now expecting hospitals to have these teams in place. But the local hospitals that are using RRTs say the requirements aren’t dictating the implementation of these teams; the results are. The goal of RRTs is to decrease emergency cardiac events that occur outside the critical care unit. When nurses and other hospital staff recognize deteriorating conditions in a patient, they call the RRT for immediate intervention. “The purpose is to assess and rescue a patient before resuscitation is necessary,” explained Rusty Maraman, RN, nurse manager of Surgical ICU and Neuro ICU at Trinity Medical Center. “Studies show that the patient has a higher chance of survival if they are in an ICU when they arrest, because everything is there. The idea is to get to the patient quickly when they start experiencing symptoms of demise and rescue that patient before something worse happens. It’s actually designed to provide early transfer to the ICU and at the same time to prevent unnecessary transfers to the ICU.” Brookwood Medical Center implemented their RRT in November 2005, and they are reporting a 47 percent reduction in non-ICU codes and a 17 percent overall reduction in code events. In a 22-month period, RRT consultations increased by 1.5 times, while non-ICU codes and mortality decreased. At Trinity Medical Center, where they implemented their RRT in September 2006, they have reduced the number of cardio-pulmonary arrests outside the ICU “significantly,” according to Maraman. “Our goal starting out was 50 percent, and I’d say we’re almost there.” St. Vincent’s East established its RRT in December 2006. “It’s working well for us,” said Chuck Nelson, nurse educator. “We’ve had anywhere from six a month to one a month, but we have found that when we intervene, if we’re called fast enough, we can intervene with these patients and either they stay on the floor, or when they move to the unit, they’re not nearly as sick as if they had coded on the floor. The med-surg nurses love them. They’re not stuck there by themselves, and they have an extra pair of hands and eyes to help them get through it. Critical care nurses like it too, because if the patients do come to the unit, they don’t tend to be nearly as critical. We have better outcomes, and everybody’s happy with that.” While RRTs can consist of a variety of caregivers, several local hospitals opt for teams with critical care nurses and a respiratory therapist in consultation with a physician. “ICU nurses are more attuned to subtle changes in patients,” said Maraman, allowing for a more rapid and effective intervention. “This team is designed to get to the bottom of the issue very quickly.” The success of RRTs hinges on the nursing staff alerting them to patients who are in need of their care. Nurses are urged to activate the RRT if they see a change in the heart rate, respiratory rate or level of consciousness of the patient, as well as significant bleeding, depressed oxygen saturation, severe unexplained pain, a change in urine output or any other acute change. The teams have a pre-approved set of orders that allows them to draw some labs, but physicians are alerted and on call to approve additional orders as needed. “We gave guidelines,” said Kris Cherry, administrative director of Critical Care Services at Brookwood. “But we also said, ‘If you just don’t feel like the patient looks right, call us.’ Sometimes there isn’t a clinical, hard parameter, but if the patient doesn’t look right, we’ll also accept those calls and we’ll make no judgment on any call we receive.” She continued, “When we first started, about 26 percent of our calls were related to a patient just not looking or feeling right. That has actually decreased as we’ve done more education for our staff and they are able to give us definitive, clinical signs that they want us to assist with. But none of our calls were inappropriate. Initially that was some concern, that we would get calls for ‘I just need help putting the patient on the bedpan,’ but we did not receive any inappropriate calls at all.” Nelson reports a similar experience at St. Vincent’s East. “If they called us, there was something not right about the patient.” Cherry says that within the next six months they hope to move to educating patients and family members so they can initiate the RRT along with the nursing staff. This raises the chance of unnecessary calls, but it also raises the chance of saving more lives and intervening more quickly. “We would give some education and guidelines up front to all patients,” she said. “Some facilities in the nation have implemented that piece of it, but not a lot. But that’s how it all started. There was a pediatric situation where a child was deteriorating and that family member was able to identify it. That was the impetus for Rapid Response Teams being implemented.” Whether the hospitals report hard data or simply provide a sense of satisfaction with how they work, Rapid Response Teams are clearly resulting in improved care and saved lives. December 2007