There are many examples of RRTs improving safety
These are some examples of hospitals that have seen improvements in patient safety and outcomes from the use of rapid response teams (RRTs):
- Sutter Solano Medical Center in Vallejo, CA, implemented an RRT program on July 1, 2005, in which a hospitalist is the first responder, says Susan Waters, MD, medical director of the hospital medicine program. The team's purpose is to provide immediate response required for a deterioration in status of patients who are not in the emergency department (ED) or intensive care unit (ICU). The hospitalist assumes responsibility for the situation and directs all personnel on the team. If the patient is transferred to the ICU, the hospitalist reports the patient's status back to the staff member who activated the RRT. It is important to note that RRT members always defer to the attending physician when applicable, Waters says. Another important aspect of the program is that all Code Blues are reviewed by the Code Blue Committee to determine whether the RRT could have averted the code. During the first year of using the RRT, the number of Code Blue calls outside the ICU/ED declined 34%.
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VHA member hospitals that are using rapid response teams are rescuing patients earlier and faster, says Veronica Hunt, a spokeswoman for VHA in Chicago. In cases recently studied by VHA, RRTs helped hospital staff detect and treat patients before they experienced potentially fatal cardiac arrests. In 99 out of 150 cardiac arrest cases included in the unpublished study of RRTs in Alabama and Florida VHA facilities, the patients showed signs of deterioration during the six-hour period before the arrest, signs that were detected and acted upon by the rapid response teams. Since 2005, VHA has helped 800 hospitals nationwide implement rapid response teams. More than 75% of hospitals studied saw a decrease in mortality rates in one year, Hunt says. Hospitals saw a lower number of codes outside of the intensive care unit (ICU) and higher percentages of patients that coded or suffered a life-threatening incident and survived to discharge.
For instance, St. Vincent Hospital in Santa Fe, NM, has improved code blue survival rates as a result of implementing a RRT. Without a team, the hospital saw an initial survival rate of 64%. With a team in place, the survival rate increased to 100% during the study period. In addition, if a patient stops breathing for a second time, within 36 hours of their first event or episode, the survival rate is 94%. Without a team in place, the second episode usually resulted in a survival rate of 43%.
Hunt also cites Parkwest Medical Center in Knoxville, TN, which launched its program in January 2006, and in one year, it achieved a 40% reduction for in-patient, noncritical care codes. In addition, the hospital reduced the number of days that patients spend in the critical care unit and estimates it has avoided $520,000 in costs. - Ali Farhat, MD, chief of the hospitalist division at William Beaumont Hospital-Royal Oak in Michigan, says an RRT that began as a small project on a single unit in 2005 now is a leading hospitalwide patient safety operation. The team has provided more than 4,500 patient interventions since 2005, and has contributed to saving many lives. Despite rising patient acuity, the hospital's code rates have declined by about 20% since 2005, Farhat says. The RRT is made up of a physician extender (physician assistant or nurse practitioner), ICU nurse, and a respiratory therapist. While any employee can initiate the RRT, the nurses providing care on the floors are primarily the ones who identify even the slightest changes in their patients' conditions and initiate the call to the RRT. The hospital uses the slogan "When in doubt, give a shout!" to encourage calling the RRT. The slogan is posted in patient care areas.
Sources
For more information on hospitals with rapid response teams, contact:
- Ali Farhat, MD, Chief, Hospitalist Division, William Beaumont Hospital-Royal Oak, Royal Oak, MI. Telephone: (248) 898-8474. E-mail: [email protected].
- Veronica Hunt, VHA, Irving, TX. Telephone: (310) 659-5380. E-mail: [email protected].
- Susan Waters, MD, Medical Director, Hospital Medicine Program, Sutter Solano Medical Center, Vallejo, CA. Telephone: (707) 554-4444.
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