Rapid Response Teams Becoming More Commonplace in Hospitals

    • December 13, 2006

An increasing number of hospitals and health systems are adopting rapid response teams (RRTs) as part of their safety and quality improvement initiatives, simultaneously saving patients' lives and bolstering the nursing profession.

A rapid response team is a group of clinicians that nurses and other hospital staff can call upon at any time to provide critical care expertise at the bedside of a patient whose condition is deteriorating. The use of RRTs can improve the quality of care by reducing cardiac arrests and other acute life-threatening events, decreasing lengths of stay, and reducing patient mortality rates.

The Robert Wood Johnson Foundation (RWJF) recognizes the essential role nurses play in the success of RRTs. As part of its efforts to improve the safety and quality of patient care in hospitals, RWJF awarded grants to nine hospital systems, associations and foundations in December 2005 to encourage more widespread adoption of RRTs.

"Too often in hospitals, a nurse knows that there's something not quite right with a patient," said Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., senior program officer at the Robert Wood Johnson Foundation. "But unless the patient is displaying definitive symptoms of immediate distress, there's no established protocol that allows someone to call for help, or for a second opinion. Rapid response teams change that dynamic, giving nurses permission to ask for help, and often making the difference between life and death for a patient."

Kathy Duncan serves as faculty to the Institute for Healthcare Improvement, which provides technical assistance to the nine RRT grantees. According to Duncan, patient-centered care is at the core of the rapid response team concept.

"When the rapid response team is called to report to the bedside, the two or three additional sets of eyes are focused on the patient. The patient becomes the center of attention, and determining the appropriate course of action for the patient is the rapid response team's goal," said Duncan.

While the composition of RRTs varies at individual institutions, most hospitals have some combination of a critical care nurse, respiratory therapist, hospitalist, physician assistant, resident or fellows and pharmacist. Smaller hospitals may have only a single critical care nurse on the team.

To aid nurses in determining when to call the rapid response team, hospitals have developed a set of criteria. In many instances, the reasons for calling the RRT are straightforward, such as a change in the patient's heart rate, level of consciousness or oxygen level. On other occasions, the nurse calls the RRT because of a "gut feeling" and wants an assessment of the patient's condition from clinicians with critical care expertise. The members of the RRT arrive quickly to evaluate the patient and order appropriate interventions.

St. Francis Regional Medical Center in Grand Island, Neb., is part of Catholic Health Initiatives, one of the nine organizations working to spread the adoption of RRTs through an RWJF grant. St. Francis began implementing RRTs in May 2005. Peg Gilbert, R.N., nursing quality improvement coordinator at St. Francis, said that she has never seen a program succeed as quickly as rapid response teams have.

"I've been a nurse for 30 years, and I've started lots of quality improvement programs," said Gilbert. "Rapid response teams have had a direct impact like no program I've ever seen. It has really made a difference for patients and nurses."

At St. Francis, the RRT is comprised of a critical care nurse, respiratory therapist, nursing supervisor, and the primary nurse caring for the patient. After the primary nurse reviews the patient's current situation and provides the necessary background information, the RRT makes its assessment in collaboration with the primary care nurse.

"[The rapid response team] is a call away," says Christina Marie Salinas, R.N., a primary care nurse at St. Francis who has called RRTs when her patients need critical care expertise. "To have someone here within five minutes is just an overwhelming, wonderful feeling for both me and that patient."

Gilbert says the key to the success of the RRT is the sensitivity training its members receive as part of their educational preparations. The rapid response team recognizes that it is never a waste of their time to assess a patient. Additionally, primary care nurses recognize that it is perfectly acceptable to contact the RRT.

St. Francis has seen a steady increase in the number of calls the rapid response team receives, averaging 10 to 20 calls each month. While calls to the RRT have increased, there are now fewer code blue calls (the commonly-used internal notification system that summons immediate assistance when a patient has stopped breathing and/or his heart has stopped beating). After the first year of the program, St. Francis saw a 38 percent reduction in the number of codes outside of the critical care areas, and last month, St. Francis had no codes outside of the critical care area.

Catholic Health Initiatives is committed to rapid response teams, implementing them at St. Francis and the other 70 wholly-owned hospitals in its system. Since these hospitals began adopting RRTs, Catholic Health has seen a 6 percent reduction in its overall mortality rate.

"We believe that rapid response teams will only become more important to our hospitals and our patients," said Mary Osborne, R.N., director of clinical performance improvement for Catholic Health Initiatives.

Several of the hospitals participating in RWJF's Transforming Care at the Bedside program have also introduced rapid response teams. At one of those hospitals, the University of Pittsburgh Medical Center (UPMC) Shadyside, the RRT saved 13 lives in just one year.

UPMC has expanded the rapid response team concept so that family members and patients can call the team for help. The program, called Condition H, provides a hotline that patients or family members can call for immediate help when they feel that a change in the patient's condition is not being addressed, or when there is confusion about how care is being delivered to the patient. A team of clinicians assesses the situation and provides the necessary support.

UPMC Shadyside worked on the development of Condition H, the first program of its kind in the country, with Sorrel King, whose 18-month-old daughter Josie died in another hospital facility as a result of poor communication and hospital errors.