Rapid response team integration at a quaternary care academic centre: new paradigm for critical care organistions

BackgroundDecompensating patients require expeditious and focused care at the bedside. This can be particularly challenging when there are multiple layers of providers, each with differing specialisation, experience and autonomy. We examined the impact of our intensivist-driven hospital-wide rapid response team (RRT) at our 1171-bed quaternary care centre.DesignSingle-centre retrospective cohort study.MethodsRRT service was implemented to assess, manage and triage acutely ill patients outside the intensive care unit (ICU). Criteria for consultation and workflow were established. The 24/7 team was led by an intensivist and included nurse practitioners and respiratory therapists. Over 3 years, we reviewed the impact of the RRT on patient outcomes and critical care support beyond the ICU.ResultsOver 3 years, the RRT received 31 392 consults for 12 122 individual patients averaging 30 consults over 24 hours. 58.9% of the calls received were for sepsis alerts/risk of decompensation and 41.1% of the consults were for reasons of acute decompensation. Among patients that were seen by the RRT, over the course of their hospital stay, 14% were upgraded to a step-down unit, 18% were upgraded to the ICU and 68% completed care without requiring any escalation. The average mortality rate for patients seen by the RRT service during their hospital stay was 11.3% with an average 30-day readmission rate of 16.5% and average hospital length of stay 16 days without significant variation between the 3 years.ConclusionsIntensivist-led RRT ensured consistent high value care. Early intervention and consistent supervision enabled timely and efficient delivery of critical care services.

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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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Evaluating a New Rapid Response Team

AACN Advanced Critical Care ◽

10.4037/nci.0b013e318240e2f9 ◽

2012 ◽

Vol 23 (1) ◽

pp. 32-42 ◽

Cited By ~ 1

Author(s):

Kimberly Scherr ◽

Donna M. Wilson ◽

Joan Wagner ◽

Maureen Haughian

Keyword(s):

Patient Outcomes ◽

Nurse Practitioners ◽

Rapid Response Team ◽

Care Quality ◽

Rapid Response ◽

Mixed Methods Study ◽

Rapid Response Teams ◽

Response Team ◽

Paper Survey ◽

Improve Hospital

Evidence is needed to validate rapid response teams (RRTs), including those led by nurse practitioners (NPs). A descriptive-comparative mixed-methods study was undertaken to evaluate a newly implemented NP-led RRT at 2 Canadian hospitals. On the basis of data gathered on 255 patients who received an RRT call compared with the patient data for the previous year, no significant differences in the number of cardiorespiratory arrests, unplanned intensive care unit admissions, and hospital mortality were found. In addition, no significant differences in patient outcomes were identified between the NP-led and intensivist physician-led RRT calls. A paper survey revealed that ward nurses had confidence in the knowledge and skills of the NP-led RRT and believed that patient outcomes were improved as a result of their RRT call. These findings indicate that NP-led RRTs are a safe and effective alternative to intensivist-led teams, but more research is needed to demonstrate that RRTs improve hospital care quality and patient outcomes.

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Reduced frequency of cardiopulmonary arrests by rapid response teams

Einstein (São Paulo) ◽

10.1590/s1679-45082012000400009 ◽

2012 ◽

Vol 10 (4) ◽

pp. 442-448 ◽

Cited By ~ 3

Author(s):

Paulo David Scatena Gonçales ◽

Joyce Assis Polessi ◽

Lital Moro Bass ◽

Gisele de Paula Dias Santos ◽

Paula Kiyomi Onaga Yokota ◽

...

Keyword(s):

Hospital Mortality ◽

Rapid Response Team ◽

Rapid Response ◽

High Complexity ◽

Rapid Response Teams ◽

Cardiorespiratory Arrest ◽

Reduced Frequency ◽

Before And After ◽

Response Team ◽

The Impact

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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1202: INTENSIVE CARE UNTETHERED: EXPANDING CRITICAL CARE THROUGH A NOVEL RAPID RESPONSE TEAM

Critical Care Medicine ◽

10.1097/01.ccm.0000529206.03214.a5 ◽

2018 ◽

Vol 46 (1) ◽

pp. 585-585

Author(s):

Rohit Gupta ◽

Michael Kitz ◽

Jennifer Wang ◽

Allison Glasser ◽

Sarah Connolly ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Rapid Response Team ◽

Rapid Response ◽

Response Team

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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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