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

2014 ◽  
Vol 34 (1) ◽  
pp. 51-59 ◽  
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.

Evaluating a New Rapid Response Team

2012 ◽  
Vol 23 (1) ◽  
pp. 32-42 ◽  
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.

scholarly journals Reduced frequency of cardiopulmonary arrests by rapid response teams

2012 ◽  
Vol 10 (4) ◽  
pp. 442-448 ◽  
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.

Designing a Critical Care Nurse–Led Rapid Response Team Using Only Available Resources: 6 Years Later

2014 ◽  
Vol 34 (3) ◽  
pp. 41-56 ◽  
Author(s):  
Anne Mitchell ◽  
Marilyn Schatz ◽  
Heather Francis
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Patient Safety ◽  
Intensive Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Rapid Response Teams ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Response Team

Rapid response teams have been introduced to intervene in the care of patients whose condition deteriorates unexpectedly by bringing clinical experts quickly to the patient’s bedside. Evidence supporting the need to overcome failure to deliver optimal care in hospitals is robust; whether rapid response teams demonstrate benefit by improving patient safety and reducing the occurrence of adverse events remains controversial. Despite inconsistent evidence regarding the effectiveness of rapid response teams, concerns regarding care and costly consequences of unaddressed deterioration in patients’ condition have prompted many hospitals to implement rapid response teams as a patient safety strategy. A cost-neutral structure for a rapid response team led by a nurse from the intensive care unit was implemented with the goal of reducing cardiopulmonary arrests occurring outside the intensive care unit. The results of 6 years’ experience indicate that a sustainable and effective rapid response team response can be put into practice without increasing costs or adding positions and can decrease the percentage of cardiopulmonary arrests occurring outside the intensive care unit. (Critical Care Nurse. 2014; 34[3]:41–56)

Evolution and Evidence for Rapid Response Teams (DRAFT)

2018 ◽  
Author(s):  
Muhammad Tahseen ◽  
Richard L. Simmons
Keyword(s):  
Rapid Response Team ◽  
Healthcare Facility ◽  
Rapid Response ◽  
Rapid Response Teams ◽  
Healthcare Organizations ◽  
Response Team ◽  
National Patient ◽  
Recognition And Response ◽  
Meta Analyses ◽  
The Impact

A rapid response system (RRS) is a program designed to respond in a timely, organized, and comprehensive manner to a patient’s urgent unmet medical need within a healthcare facility. The goals of the rapid response team (RRT) are to restore homeostasis, prevent further physiologic deterioration, and establish an optimal environment of care. RRTs are now in widespread use in the US because of the Joint Commission’s national patient safety goals, which required that healthcare organizations improve recognition and response to changes in a patient’s condition. Recent meta-analyses have now concluded that RRT is effective in reducing the incidence of cardiac arrests within hospitals. There is still controversy, however, on the impact of RRT on ultimate clinical outcomes, including mortality. In this chapter, we review the history and evolution of RRTs, rationale for its existence, its impact on patient outcomes, and current controversies.

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

2021 ◽  
pp. postgradmedj-2020-137497
Author(s):  
Rohit R Gupta ◽  
Cristhian Gonzalez ◽  
Jennifer Wang ◽  
Miguel Martillo ◽  
Roopa Kohli-Seth
Keyword(s):  
Critical Care ◽  
Hospital Stay ◽  
Nurse Practitioners ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
New Paradigm ◽  
Average Hospital ◽  
Response Team ◽  
The Impact

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.

Rapid Response Teams: Qualitative Analysis of Their Effectiveness

2013 ◽  
Vol 22 (3) ◽  
pp. 198-210 ◽  
Author(s):  
Linda Searle Leach ◽  
Ann M. Mayo
Keyword(s):  
Time Pressure ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Multiple Perspectives ◽  
Rapid Response Teams ◽  
Effective Response ◽  
Team Members ◽  
Grounded Theory Method ◽  
Response Team ◽  
Patients At Risk

Background Multidisciplinary rapid response teams focus on patients’ emergent needs and manage critical situations to prevent avoidable deaths. Although research has focused primarily on outcomes, studies of the actual team effectiveness within the teams from multiple perspectives have been limited. Objective To describe effectiveness of rapid response teams in a large teaching hospital in California that had been using such teams for 5 years. Methods The grounded-theory method was used to discover if substantive theory might emerge from interview and/or observational data. Purposeful sampling was used to conduct in-person semistructured interviews with 17 key informants. Convenience sampling was used for the 9 observed events that involved a rapid response team. Analysis involved use of a concept or indicator model to generate empirical results from the data. Data were coded, compared, and contrasted, and, when appropriate, relationships between concepts were formed. Results Dimensions of effective team performance included the concepts of organizational culture, team structure, expertise, communication, and teamwork. Conclusions Professionals involved reported that rapid response teams functioned well in managing patients at risk or in crisis; however, unique challenges were identified. Teams were loosely coupled because of the inconsistency of team members from day to day. Team members had little opportunity to develop relationships or team skills. The need for team training may be greater than that among teams that work together regularly under less time pressure to perform. Communication between team members and managing a crisis were critical aspects of an effective response team.

Pharmacists as Members of the Rapid Response Team

2014 ◽  
Vol 29 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Christine M. Groth ◽  
Nicole M. Acquisto
Keyword(s):  
Chart Review ◽  
Cardiopulmonary Arrest ◽  
Rapid Response Team ◽  
Medication Administration ◽  
Rapid Response ◽  
Rapid Response Teams ◽  
Early Therapy ◽  
Patient Demographics ◽  
Time Commitment ◽  
Response Team

Purpose: Rapid response teams (RRTs) have been developed to provide early therapy to patients with risk factors for cardiopulmonary arrest. We sought to investigate the role a pharmacist could have as a member of the RRT. Methods: Two pharmacists trained in critical care and emergency medicine proposed a pilot program to determine whether a pharmacist as a member of the RRT could help to optimize pharmacotherapy and facilitate medication administration. During response, 1 pharmacist was at the bedside with the RRT for patient evaluation, consult, chart review, and to facilitate medication administration. The responding RRT pharmacist collected patient demographics, medications administered, pharmacotherapy recommendations, and time commitment. Results: The pharmacists responded to 32 RRT alerts. A majority (65.6%) of patients required at least 1 medication, and a total of 45 medications were administered. The pharmacists performed 49 pharmacotherapy-related interventions in 21 patients. These included medication facilitation (15), dose (15) or therapy (8) recommendations, and adding (6) or discontinuing (5) a medication. The pharmacists spent a median time of 15 minutes (interquartile range [IQR] 15, range 2-70) for each RRT alert and a total of 612 minutes (10.2 hours). Conclusion: With a minimal time commitment, pharmacists can be valuable members of the RRT.

Early Warning Score Communication Bundle: A Pilot Study

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.

scholarly journals Effect of a Rapid Response Team on Patient Outcomes in a Community-Based Teaching Hospital

2014 ◽  
Vol 6 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Ankur Segon ◽  
Shahryar Ahmad ◽  
Yogita Segon ◽  
Vivek Kumar ◽  
Harvey Friedman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Inpatient Mortality ◽  
Rapid Response Teams ◽  
Community Based ◽  
Code Blue ◽  
Response Team

Abstract Background Rapid response teams have been adopted across hospitals to reduce the rate of inpatient cardiopulmonary arrest. Yet, data are not uniform on their effectiveness across university and community settings. Objective The objective of our study was to determine the impact of rapid response teams on patient outcomes in a community teaching hospital with 24/7 resident coverage. Methods Our retrospective chart review of preintervention-postintervention data included all patients admitted between January 2004 and April 2006. Rapid response teams were initiated in March 2005. The outcomes of interest were inpatient mortality, unexpected transfer to the intensive care unit, code blue (cardiac or pulmonary arrest) per 1000 discharges, and length of stay in the intensive care unit. Results Rapid response teams were activated 213 times during the intervention period. There was no statistically significant difference in inpatient mortality (3.13% preintervention versus 2.91% postintervention), code blue calls (3.09 versus 2.89 per 1000 discharges), or unexpected transfers of patients to the intensive care unit (15.8% versus 15.5%). Conclusions The implementation of a rapid response team did not appear to affect overall mortality and code blue calls in a community-based hospital with 24/7 resident coverage.

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