The use of rapid response teams (RRT) has increased over the past several years because of the Institute for Healthcare Improvement's call for "Protecting 5 Million Lives From Harm" (previously "Protecting 100,000 Lives From Harm").1 Rapid response teams are generally made up of a variety of healthcare providers who have advanced skills in airway management, central venous access devices, and drug management.2 The secret to the success of an RRT is that anyone who identifies a change in a patient can put the process in motion.3
BACKGROUND INFORMATION
The Kennedy Health System, consisting of 3 campuses in New Jersey, is a nonprofit acute care teaching institution. In 2006, hospital senior management and the Patient Safety Committee made a commitment to implement an RRT at our Cherry Hill campus.
A newly created multidisciplinary workgroup reviewed the literature; developed the program timeline; identified the needed team members as the senior intensive care unit medical resident, a critical care nurse, the nursing supervisor, and a respiratory therapist; and initiated the RRT in November. The workgroup identified team members' roles and responsibilities; developed call criteria, activation processes, physician order sets, and call records; and garnered physician support.
The role of the RRT is multifaceted and includes assisting with the implementation of rapid, safe, treatment decisions for patients to reverse or prevent clinical deterioration. Our initial interventions were based on standardized evidence-based protocols implemented to meet core measure requirements.
The RRT program coordinator, in conjunction with the Clinical Education and Research Department, developed the content and provided initial education sessions for all clinical hospital staff. The educators and respiratory therapists reinforced the philosophy of "no call is a bad call" and "better to call and not be needed than not to call" in all educational sessions. The critical care educators also provided advanced education for the critical care and respiratory therapy staff members, including reviewing physiology, assessment skills, evidence-based interventions, critical thinking skills, collaboration, and assertiveness techniques. Educators also instructed the RRT to turn each call into a teaching moment to support and develop the staff.
IMPLEMENTATION
Everything was ready for the "go live" date of November 7, 2006. The staff was excited about the additional support from the RRT when there was a change in the patient's condition while everyone awaited the first call with nervous tension and anticipation. That call came on November 13, 2006, at 10 PM on a general medical-surgical floor when a registered nurse, rounding on a patient, noticed a change in his condition from her earlier assessment. The registered nurse activated the RRT, who responded within 2 minutes, and then the nurse updated the team using the situation, background, assessment, and recommendation method. After 45 minutes, the patient was stabilized and transferred to a higher level of care.
OUTCOMES
The RRT received 80 calls in its first year. The team now spends an average of 20 minutes on each call, which results in 57% of patients remaining on their current units. To measure effectiveness of the RRT, the workgroup followed the recommendations of the Institute for Healthcare Improvement, using the following metrics:
* number of RRT calls
* number of codes outside the intensive care unit
* number of codes per 1,000 discharges
* mortality rate
Before the initiation of the RRT, data collection and reporting of code blue calls were inconsistent. The performance improvement (PI) department aggregated these data based on the number of completed forms that were returned to the department. Because the PI department noted that there were many code blue calls and few forms, the RRT workgroup agreed to track monthly code blue and RRT calls using the telecommunication department log. This information was used to determine if an earlier RRT call could have made a difference in the patient's outcome.
Because of the 80 calls to our RRT in the first year, our code blue calls decreased by 71% and inpatient mortality decreased from 1.8% to 0.02%. The number of code blue calls per 1,000 discharges decreased to an average of 4.83 per month.
ENDNOTE
Paramount to the success of this program is the communication and sharing of outcome data with all associates from bedside clinician to the chairman of the board of trustees. The success of the RRT would not have been possible without the vision, support, and commitment of a multidisciplinary group empowered to improve outcomes and change lives.
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