Rapid Response Teams, Saving Lives through Collaboration…

Successes and Lessons Learned

by

Kathleen Carey, RN, CNS-BC, CCRNJodi Hamel, RN, CCRN

Rapid Response Teams Institute for Healthcare Improvement (IHI) in December 2004 launched the

“One Million Lives” campaign recommending Rapid Response Teams (RRT’s) 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 RRT’s 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

Institute of Medicine Core Competencies

Provide patient-centered care

Work in interdisciplinary teams

Employ evidence-based practice

Apply quality improvement

Utilize informaticsFrom Health Professions Education: A Bridge to Quality.

Institute of Medicine, 2003

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

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

Code/Rapid Response RelationshipPer 1000 Patient Days

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2005 2006 2007 2008 2009 2010

Codes RR's

Jul-Dec '05

Utilization of Rapid Response Team

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2005 2006 2007 2008 2009 2010

# of RR # Stay in Room

Jan-Oct '10

Jul-Dec '05

Unplanned Transfers With Rapid Response2010

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Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Total Transfers Total RR Calls Total Transfers with RR

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

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

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

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

Key Elements Clinical coaching with each call 3 C’s 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

Rapid Response Team Still Not Cutting It?

RRT inconclusive; vigorous debate

Chan et al, 2010