Codes have plummeted by 50 percent outside the CCU at Brookwood Hospital thanks to their Rapid Response Team. "Basically we're designed to rescue the patient so that they do not deteriorate to a need for resuscitation. It's really bringing critical care to the bedside," said Kris Cherry, RN, DSN, CCRN, NEA-BC and the Administrative Director of Critical Care.
The Rapid Response Team consists of a critical care nurse and a respiratory therapist who respond to calls from nurses within five minutes. "We have hard criteria for calling the RRT — if the blood pressure's dropping or there's shortness of breath — but it could be just that the nurses have a feeling that something is not right," Cherry said.
Once the RRT makes a quick assessment of the patient and gathers any data needed, such as EKG or lab work, they call the physician to ask for additional interventions or orders in caring for the patient. "We make sure the physician is in the loop so they do not lose the oversight of that patient," Cherry said.
Having the critical care expertise bedside to interpret the situation when the physician is not onsite is invaluable. "When you call a physician, it's kind of hard to articulate 'well something's just not right'," Cherry said. But the RRT has the experience to translate, allowing the physician to make decisions quickly.
Twenty nurses and fifteen respiratory therapists currently rotate to serve as the on-call Rapid Response Team. "We have not hired additional staff. We felt very strongly that our critical care nurses would be the best ones to do this," Cherry said. The two-person on-call team, available 24/7 to the entire hospital, is assigned a lighter patient load and follows a process of patient hand-off should the team be called.
Brookwood started their RRT three years ago and have since responded to 500 calls resulting in a 19% drop in mortality. "We were not surprised at the numbers, because the IHI [Institute of Healthcare Improvement] says if you implement these things that you should see this percent of reduction," Cherry said.
Once a month, the critical care chair, who also serves as the Team's Physician Champion, reviews the cases, which average fifteen per month. "They look at the documentation to make sure they agree with the intervention and also to see if there are opportunities for improvement," Cherry said.
The most difficult part of the program for Cherry is needing to remind staff that the RRT exists. About every three months, the number of calls will begin to drop off. "Whenever the number of RRT calls drops, it does have an impact on the number of codes we see on the floor," Cherry said. So they step-up the departmental and PI meeting presentations and put reminders in the staff newsletter. "We reinforce our education, and immediately we see our numbers pick right back up."
Brookwood's success with their Rapid Response Team led to their designation as a Mentor last year by the IHI. About five hospitals from around the nation have called for consultations so far. The most common dilemmas pertain to training, collecting data, and getting staff on board with the program. "Whatever they request, we share — processes, tools, and curriculum," Cherry said.
The curriculum was devised by Cherry. Despite the RRT being a national initiative by IHI, each facility builds their own curriculum, protocols and recruitment policies. "While you might make a template of a curriculum nationally, it will really vary with the population you serve and the hospital size," Cherry said.
Based on their data, Brookwood found that most of their calls were respiratory-related, so they focused heavily on respiratory education in their curriculum. "But as time has rolled along, we've added initiatives related to that, for example sepsis," Cherry said.
The newest expansion in the program started a month ago. Patients and their family can now call in the Rapid Response Team. "They can call us using a designated help line for situations that they might call 911 for at home," said Tonya Roddam, RN, BSN, who heads up this part of the initiative. Debbie Hollenstein, spokesperson for Brookwood, explained, "This is not replacement of the nurse, but in concert with the nurse. They're an extra pair of eyes. They know this patient better even than we do."
According to national input, the patient/family calls will remain low volume, just a few per month. "But now everyone who has ownership in that patient's care has an avenue to bring in the RRT if they feel like it's necessary," Cherry said.
Surveys of physicians and nurses show the majority are very pleased with the RRT. "Nurses are receiving this well because it gives them another tool for situations they may not feel prepared to deal with on a daily basis," Hollenstein said.
"The most important thing is that impact on patient outcome," Cherry said. "That's what keeps our staff excited, is seeing that data and seeing those numbers."
