Rapid Response Teams, Saving Lives through Collaboration… Successes and Lessons Learned by Kathleen Carey, RN, CNS-BC, CCRN Jodi Hamel, RN, CCRN

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Rapid Response Teams, Saving
Lives through Collaboration Successes and
Lessons Learnedby Kathleen Carey, RN, CNS-BC,
CCRNJodi Hamel, RN, CCRN
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Rapid Response Teams

• Institute for Healthcare Improvement (IHI) in
  December 2004 launched the One Million Lives
  campaign recommending Rapid Response Teams
  (RRTs) be placed in hospitals
• More than 3000 hospitals participated in the
  campaign
• 2005 RWJ funded learning networks for
  implementation
• IHI unveiled Five Million Lives campaign
  expansion in 2006
• 2007 RRTs were in more than1500 US Hospitals
• US News and World Report and the Wall Street
  Journal reported the potential benefit of RRT
• 2008 Joint Commission added NPSG 16A

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Institute of Medicine Core Competencies

• Provide patient-centered care
• Work in interdisciplinary teams
• Employ evidence-based practice
• Apply quality improvement
• Utilize informatics
• From Health Professions Education A Bridge
  to Quality.
• Institute of Medicine, 2003

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Purpose and Goals of RRTs

• Rapid response teams are expert clinicians who
  respond and provide interventional care to
  patients experiencing acute changes in their
  conditions. The goals of the team are to
  recognize early signs of patient deterioration
  and to prevent avoidable code events.
• IHI recommends a goal of 25 RRT calls per 1000 pt
  discharges or 10 calls per every 100 occupied beds

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CVPH Rapid Response JourneySaving Lives through
Collaboration

• CVPH is 341 bed non-profit community hospital
• Rapid Response Team (RRT) began in July 2005
• Nurse Consultation Model, Lewin's Change and
  Watson's Caring Theory theoretical framework
• Systems analysis and improvement
• RN empowerment
• Physician and staff education
• Response team consists of an ICU RN, RT, PCC

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Jul-Dec '05
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Jan-Oct '10
Jul-Dec '05
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Promoting Nursing's Future The Nursing
Consultation Model

• Reduction of inpatient codes (exclude ICU)
• Education through nursing consultation
• Save of the Month
• Implementation of family RR calls
• Collaboration of healthcare team
• Growth of consultation models

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Promoting Nursing's Future A Bridge to Clinical
Wisdom

• RR calls decrease transfers to HLOC
• Yearly education
• Admission brochure (Soarian)
• Annual Executive Board presentation
• Call early call often
• Story telling at Hospital Practice Council
• Dynamic rapid response practice team

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Lessons Learned

• Staff perceptions
• Resistance to change
• Physicians perceptions
• Delay in calling
• Clinical grasp
• Clinical inquiry

• Staffing
• Skilled know-how of coaching
• Newly hired staff/physicians
• Family RRT calls
• Unplanned transfers

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Conclusions

• RRT widely accepted
• 8-12 reduction in codes outside ICU
• 13 increase in RR calls
• 74 of calls patients remain in room
• 32/month unplanned transfers
• 75 of transfers are without RR call
• Senior leadership support
• Nursing consultation model growth
• Family initiated calls slow progress

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Key Elements

• Clinical coaching with each call
• 3 Cs computer, chart, caller
• Embrace clinical inquiry
• I need another set of hands
• Invite senior leadership to Save of the Month
  recognition
• Family/patient education on admission
• Hardwire RRT process with ongoing education
• Perception awareness

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Rapid Response Team Still Not Cutting It?

• RRT inconclusive vigorous debate

Chan et al, 2010
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