Rapid Response Teams
Category: Uncategorized
Author: Georgina Tyburski
Posted: Friday - October 16, 2015
The formation of rapid response teams (RRT’s) at hospital was founded on the concept of failure to rescue. Failure to rescue refers to health care providers lacking to recognize early signs and symptoms of deterioration in a patient’s condition, or acting too late to prevent a cardiac arrest.
What is a rapid response team? The team is a designated group of healthcare providers who can come together quickly to deliver critical care expertise in a rapid moment in a grave clinical deterioration of a patient located outside a critical care unit. The team may consist of Physician, Physician Assistant, Critical Care RN, Clinical Nurse Specialist, and or Respiratory Therapist. There are three key features of the team members:
They MUST be available to respond immediately when called, and not be constrained by competing responsibilities. They must be onsite and accessible and they must have the critical care skills necessary to assess and respond to the immediate situation.
Three fundamental problems lead to failure to rescue hospitals:
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Failures in planning (this includes patient assessments, treatments and goals)
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Breakdown of communication between patients and healthcare providers or breakdown in communication between healthcare providers and other healthcare providers.
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Failure to recognize early signs of deterioration in a patient’s condition.
The Institute for Healthcare Improvement (IHI) encouraged American Hospitals to implement rapid response teams. Many facilities implement rapid response teams locally since they have an established standard of care.
Research has shown since rapid response teams have been instituted, there has been 50% reduction in the occurrence of cardiac arrest outside the ICU. Severe postoperative adverse events such as respiratory failure, stroke, severe sepsis, and acute renal failure have decreased by 58%. Emergency ICU admits were decreased by 44%, postoperative deaths were reduced by 37% and hospital stays decreased from 23.8 to 19.8 days in surgical patients.
Most hospitals have developed a set of criteria that signify a patient’s condition deteriorating, for which the staff nurse will activate the RRT. The goal is to treat these warning signs early so that the patient’s outcome may be improved and a cardiac arrest is prevented. Some of the criteria signs include changes in heart rate, systolic blood pressure, respiratory rate, pulse oximetry saturation, mental status or urinary output have changed. Other criteria may include changes in laboratory values such as sodium, glucose, and potassium which could indicate a patient’s condition is deteriorating. The nurse may call the team just by having that “gut” intuition that something is not going well. Some hospitals have gone as far as allowing family members to call a designated posted phone number when they feel they see a change in their loved one’s condition.
The role of the RRT consists of several key notes. They assist staff members in assessing and stabilizing the patient condition. They assist the staff member in organizing information to be communicated to the patient’s physician. Education and support staff members as they care for a deteriorating patient. If the patient’s condition continues to warrant a higher level of care the RRT can facilitate the transfer to that critical level of care. The RRT does not replace the patient’s physician, they are only available to act proactively during the immediate need and then the patient’s physician is notified and updated on the patient’s status. The team is usually trained to communicate and receive communication using the SBAR (situation, background, assessment and recommendation).
Documentation completes the circle of communication and becomes a part of the patient’s medical record. Many facilities utilize the computerized system or during critical times a structured documentation form in paper format is used. A template for a RRT documentation tool can be found at the IHI website. The National Registry of CPR also provides a documentation template.
When your nurse is reviewing your client’s medical records, did they become a victim of failure in planning, poor assessments and poor communication among health care providers resulting in their cardiac arrest? Is your client a fortunate patient to be one of the surviving statics from the positive interventions of a successful rapid response team?
The National Registry of CPR
