1 / 28

Rapid Response Teams

Rapid Response Teams. New Jersey Council of Teaching Hospitals April 19, 2005 Terri Simmonds, RN Michael Leonard, MD. The Rapid Response Team a.k.a Medical Emergency Team. … is a team of clinicians who bring critical care expertise to the bedside (or wherever it’s needed). Goal

xenia
Download Presentation

Rapid Response Teams

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Rapid Response Teams New Jersey Council of Teaching Hospitals April 19, 2005 Terri Simmonds, RN Michael Leonard, MD

  2. The Rapid Response Teama.k.a Medical Emergency Team • … is a team of clinicians who bring critical care expertise to the bedside (or wherever it’s needed). • Goal • Prevent deaths in patients who are failing outside intensive care settings by implementing rapid response teams (RRTs).

  3. Why Rapid Response Teams? • People die unnecessarily every single day in our hospitals.

  4. Mortality Diagnostic – 2 x 2 matrix ICU Admission ? Yes No Yes Box #1 Box #2 Comfort Care Only? No Box #3 Box #4

  5. US 2X2 Table Aggregate64 Hospitals – updated October 2004

  6. Three fundamental problems • Failures in planning • includes assessments, treatments, goals • Failure to communicate • patient to staff, staff to staff, staff to physician, etc. • Failure to recognize • These three problems often lead to failure to rescue

  7. Clinical Instability Prior to Arrest • 70% (45/64) arrests with evidence of respiratory/neurologic deterioration with 8 hours (Schein, Chest 1990; 98: 1388-92) • 66% (99/150) abnormal signs and symptoms within 6 hours of arrest and MD notified 25% of cases (25/99)(Franklin, Crit Care Med;1994;22: 224-247)

  8. Clinical Instability Prior to Arrest • Warning signs within 6 hours of event: • MAP < 70 or > 130 mmHg. • Heart rate < 45 or >125 per minute • Respiratory rate < 10 or >30 per min • Chest pain • Altered mental status • Franklin and Mathew; Crit Care Med;1994;22: 224-247.

  9. What difference can an RRT make? MJA 2003; 179-7

  10. What difference can an RRT make? • 50% reduction in non-ICU arrests (Buist, BMJ 02) • Reduced post-operative emergency ICU transfers (44%) and deaths (37%) (Bellomo, CCM 04) • Reduction in arrest prior to ICU transfer (4 % v 30 %) (Goldhill, Anest 99) Rothschild, 2004

  11. Hospital Codes per 1000 Discharges (u-chart) UCL Average Codes per 1000 Discharges 23% decrease Medical Response Team (MRT) implemented August 2003 LCL (u-chart)

  12. Hospital Codes Outside the ICU Number of Codes 44 % decrease Medical Response Team (MRT) implemented August 2003

  13. Percent of Coded Patients Surviving at Discharge (p-chart) UCL Medical Response Team (MRT) implemented August 2003 Average Percent 48 % increase LCL

  14. Codes per 1000 Discharges

  15. What is the Role of the Team? • Assess • Stabilize • Assist with communication • Educate and support • Assist with transfer, if necessary

  16. Rapid Response Team Considerations • Engage senior leadership support • Determine the best structure for the team • Provide education and training • Establish criteria and mechanism for calling • Establish structured documentation tool • Establish feedback mechanisms • Measure effectiveness

  17. Engage Leadership Support • Executive and physician • Clear and wide communication strategy

  18. Determine the Team Structure • Considerations • Available • Accessible • Able • Multiple Models • ICU RN and Respiratory Therapist • ICU RN, RT, Intensivist, Resident • ICU RN, RT, Intensivist or Hospitalist • ICU RN, RT, Physician Assistant

  19. Provide Education and Training • Medical Staff • General information • Benefits • Myths

  20. Provide Education and Training • RRT • ACLS or advanced critical care training • SBAR • Communication skills • Appropriate expectations • Importance of responding in a timely manner • Importance of providing non-judgmental, non-punitive feedback to call initiator

  21. Provide Education and Training • Nursing Staff • Criteria for calling • Notification process • Communication and teamwork skills • SBAR, Assertiveness / Critical Language • Appropriate expectations • Importance of calling even when unsure • Non-judgmental, non-punitive nature of the RRT • Have information available for RRT (chart, medication administration record, etc.) • Role as a member of the team

  22. Establish Criteria for CallingFor Example…. • Staff member is worried about the patient • Acute change in heart rate <40 or >130 bpm • Acute change in systolic BP <90 mmHg • Acute change in RR <8 or >28 per min or threatened airway • Acute change in saturation <90% despite O2 • Acute change in conscious state • Acute change in UO to <50 ml in 4 hours

  23. Establish Mechanism for Calling • Beeper with or without overhead page • Encourage staff to dial from the patient’s room number, enter in the room # • If not in a patient room, dial in the extension for the RRT Team to call back for a location

  24. Communication and Documentation • Embed SBAR • Record the interventions and reasons for call • Use data to drive educational programs

  25. Feedback Mechanisms • Feedback information on patient outcome • Look for lessons learned hospital wide • Use data to drive educational programs • Share the success stories

  26. Measure Effectiveness • Key measures • Mortality • Codes per 1000 discharges • Codes outside the ICU • Number of rapid response team calls • Other possible metrics • Transfers to higher level of care (ICU or other) • Average ICU LOS for post RRT ICU transfers vs med/surg ICU admissions • Satisfaction with the RRT process • Post cardiac arrest ICU bed utilization • Safety culture survey data

  27. Possible Benefits of the Rapid Response Team • Better outcomes • Improved relationships • Improved satisfaction • Nursing • Physician • Patient • Impact on nursing retention • Financial benefits

  28. Important things to keep in mind • Be tolerant of “false alarms”. Praise and NEVER criticize for calling • Communicate, communicate, communicate! Get the word out – initially and continuously • Share the RRT stories with medical and nursing staff • Maintain continuous awareness and reinforcement of RRT through hospital publications, newsletters, etc. Keep it alive!

More Related