The Impact of a Nurse Practitioner Rapid Response Team on Systemic Inflammatory Response Syndrome Outcomes

OBJECTIVE: To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS: A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS: During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p<0.001) and 14.34 deaths/1,000 discharges (p=0.029). CONCLUSION: The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

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Early Warning Score Communication Bundle: A Pilot Study

American Journal of Critical Care ◽

10.4037/ajcc2018513 ◽

2018 ◽

Vol 27 (3) ◽

pp. 238-242

Author(s):

Cheryl Gagne ◽

Susan Fetzer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Early Warning ◽

Rapid Response Team ◽

Rapid Response ◽

Early Warning Score ◽

Early Warning Scores ◽

Response Team ◽

Intensive Care Unit Nurses ◽

The Impact

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.

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Addition of Acute Care Nurse Practitioners to Medical and Surgical Rapid Response Teams: A Pilot Project

Critical Care Nurse ◽

10.4037/ccn2014847 ◽

2014 ◽

Vol 34 (1) ◽

pp. 51-59 ◽

Cited By ~ 15

Author(s):

April N. Kapu ◽

Arthur P. Wheeler ◽

Byron Lee

Keyword(s):

Acute Care ◽

Nurse Practitioners ◽

Rapid Response Team ◽

Pilot Project ◽

Rapid Response ◽

Therapeutic Interventions ◽

Rapid Response Teams ◽

Care Nurse ◽

Response Team ◽

The Impact

BackgroundVanderbilt University Hospital’s original rapid response team included a critical care charge nurse and a respiratory therapist. A frequently identified barrier to care was the time delay between arrival of the rapid response team and arrival of the primary health care team.ObjectiveTo assess the impact of adding an acute care nurse practitioner to the rapid response team.MethodsAcute care nurse practitioners were added to surgical and medical rapid response teams in January 2011 to diagnose and order treatments on rapid response calls.ResultsIn 2011, the new teams responded to 898 calls, averaging 31.8 minutes per call. The most frequent diagnoses were respiratory distress (18%), postoperative pain (13%), hypotension (12%), and tachyarrhythmia (10%). The teams facilitated 360 transfers to intensive care and provided 3056 diagnostic and therapeutic interventions. Communication with the primary team was documented on 97% of the calls. Opportunities for process improvement were identified on 18% of the calls. After implementation, charge nurses were surveyed, with 96% expressing high satisfaction associated with enhanced service and quality.ConclusionsTeams led by nurse practitioners provide diagnostic expertise and treatment, facilitation of transfers, team communication, and education.

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Improving Patient Safety through the Use of Nursing Surveillance

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-51.s2.34 ◽

2017 ◽

Vol 51 (s2) ◽

pp. 34-43 ◽

Cited By ~ 2

Author(s):

Karen K. Giuliano

Keyword(s):

Patient Care ◽

Clinical Care ◽

Warning System ◽

Rapid Response Team ◽

Hospital Length ◽

Rapid Response ◽

Hospital Length Of Stay ◽

Clinical Implications ◽

Response Team ◽

The Impact

Surveillance and monitoring each represent a distinct process in patient care. Monitoring involves observation, measurement, and recording of physiological parameters, while surveillance is a systematic, goal-directed process based on early detection of signs of change, interpretation of the clinical implications of such changes, and initiation of rapid, appropriate interventions. Through use of an illustrative clinical example based on Early Warning System scoring and rapid response teams, this article seeks to distinguish between nurse monitoring and surveillance to demonstrate the impact of surveillance on improving both care processes and patient care. Using a clinical example, differences between surveillance and monitoring as a trigger for deployment of the rapid response team were reviewed. The use of surveillance versus monitoring resulted in a mean reduction in rapid response team deployment time of 291 minutes. The median hospital length of stay for patients whose clinical care included using surveillance to initiate the deployment of the rapid response team was reduced by 4 days. Monitoring relies on observation and assessment while nursing surveillance incorporates monitoring with recognition and interpretation of the clinical implications of changes to guide decisions about subsequent actions. The clinical example described here supports that the use of an automated surveillance system versus monitoring had a measurable impact on clinical care.

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The Impact of Rapid Response Team Activation on Unplanned Transfers to the ICU

10.28971/532021ne89 ◽

2021 ◽

Author(s):

Erica Nelson

Keyword(s):

Systematic Review ◽

Rapid Response Team ◽

Rapid Response ◽

Healthcare Improvement ◽

Number Of Patients ◽

Pubmed Database ◽

Response Team ◽

Hospital Morbidity ◽

Unplanned Admissions ◽

The Impact

Rapid Response Teams (RRTs) were addressed by the Institute for Healthcare Improvement (IHI) as a means for improving inpatient hospital morbidity and mortality. There implementation was encouraged nationwide with the goal to decrease inpatient cardiopulmonary arrests, mortality rates and unplanned admissions to the Intensive Care Unit (ICU). The purpose of this systematic review was to evaluate the impact of RRTs on unplanned transfers to the ICU. A comprehensive literature review was performed using the PubMed database focusing on RRTs and unplanned ICU transfers. The Donabedian model was used as the theory for this review in conjunction with the PRISMA framework. Study specific data and data outcomes were extracted from individual studies and recorded in tables. Critical appraisal of the included studies was performed utilizing the CASP Checklist for cohort studies. Cross study analysis was then performed to compare outcomes of individual studies against one another in the form of a table. The findings of this systematic review addressed the impact of RRT on ICU admissions with varying outcomes in regards to number of patients admitted to the ICU after RRT review, APACHE scores, length of stay, and mortality. Results of this study address limitations of the identified research and recommendations and implications for the role of the advanced practice nurse.

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The effect of the duration between urine culture and semirigid ureteroscopic on the rate of systemic inflammatory response syndrome postoperatively

10.22541/au.161282090.06660085/v1 ◽

2021 ◽

Author(s):

Fatih Akkaş ◽

Emre Sam ◽

Ahmet Cinislioglu ◽

İbrahim Karabulut ◽

Fatih Kursat Yilmazel ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Urine Culture ◽

Systemic Inflammatory Response ◽

Binary Logistic Regression Analysis ◽

Ureteroscopic Lithotripsy ◽

Entire Study ◽

Significant Difference ◽

The Impact ◽

Bladder Urine

Purpose: The aim of this study is to analyze the preoperative and intraoperative factors that might induce systemic inflammatory response syndrome after semirigid ureteroscopic lithotripsy (SULL) , and to evaluate the impact of duration between preoperative bladder urine culture (PBUC) and surgery on postoperative systemic inflammatory response syndrome (SIRS). Methods: A retrospective review was conducted including patients who underwent SULL in our center between January 2011 and June 2020. Prior to surgery, PBUC were obtained from all patients and postoperatively patients were observed for signs of SIRS. Univariable and multivariable binary logistic regression analysis were implemented to demonstrate the factors that predict SIRS postoperatively. Results: The entire study included a cohort of 572 patients. The rate of SIRS following SULL was 1.7%. Predictive factors for SIRS were listed as stone volume, surgical time, and history of recurrent urinary tract infection. No significant difference was detected in terms of the duration between PBUC and SULL when comparing the SIRS group with the other group. Conclusion: The duration between PBUC and SULL is not an efficacious factor for SIRS. It may be useful to conduct prospective studies to enlighten this issues as endourologists deal with this duration dilemma often in daily practice. Keywords: Semirigid ureteroscopic lithotripsy, Systemic inflammatory response syndrome, Preoperative bladder urine culture

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Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa114 ◽

2020 ◽

Author(s):

Hermano Alexandre Lima Rocha ◽

Antonia Célia de Castro Alcântara ◽

Fernanda Colares de Borba Netto ◽

Flavio Lucio Pontes Ibiapina ◽

Livia Amaral Lopes ◽

...

Keyword(s):

Tertiary Care ◽

Rapid Response Team ◽

Lessons Learned ◽

Rapid Response ◽

Initial Assessment ◽

Care Hospital ◽

Large Tertiary Care ◽

Response Team ◽

Hospital Wards ◽

The Impact

Abstract Quality problem or issue Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). Initial assessment An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. Choice of solution Adequacy of workforce sizing. Implementation The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. Evaluation After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. Lessons learned The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.

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