2006 OPEN FORUM Abstracts
Rapid Response Team - a Reduction in Cardiac Arrests:
John Sabo, MS, RN, RRT and Joy Hargett, BS, RRT, Walter
Goldsberry, RRT, Doretha Mitchell, RRT, Ikechukwu Nworah, RRT, and Patrick
Schexnaider, RRT, St. Luke's Episcopal Hospital, Houston, Texas
Background: The Rapid Response Team or
Emergency Medical Team is a new concept to the United States. Instituted in Australia and now recommended
by the Institute of Health Improvement (IHI) as part of the 100,000 Lives
Campaign, many hospitals are embracing this aspect of having an immediate
response team for a patient with declining health conditions of a potential
serious nature.
Method: In order to address this IHI initiative,
our Respiratory Care Department was asked by the Patient Safety and Quality Department
to provide a respiratory therapist to attend the Rapid Response calls. Due to hospital's medical staff and medical
school affiliation, the greatest need for a Rapid Response team appeared to be
in the evening, night, and weekend shifts. The Team was named the "R-Team". The
team would consist of a registered nurse (RN), respiratory therapist (RT), and
medical resident. RN's with critical care experience were hired with the R-Team
being their primary job responsibility. In order to meet this and other
department needs, a decision was made to change the management structure of the
Respiratory Care Department. Previously,
the department utilized a 3-person supervisor management structure, with charge
therapists covering weekends, holidays, and vacations. Supervisory coverage was changed to a
4-person "operational" supervisory
structure whose team works 7 days a week, 24 hours a day. These operational supervisors run the
day-to-day clinical activities of the department. Operational supervisors do not routinely take
a specific work assignment unless staffing dictates, but do spend about 50% of
their shift providing patient care activities.
This allows them to be available for R- Team calls. The R-Team is available
each weekday from 7p -7a and all weekend, until Monday morning at 7am. No additional clinical training was provided
to the Respiratory Care staff prior to initiation of the team and this group
has taken real ownership of this responsibility. R-Team calls take 30 - 60 minutes, depending
on the patient's condition and clinical needs.
Results: The R-Team began on
September 19, 2005, with a short hiatus, due to the impending arrival of
Hurricane Rita to the Texas Gulf Coast.
The team reconvened after hurricane activities ended. Statistics showed the following: Number of R-Team calls: September -
20; October - 68; November - 76 and December - 85. Major clinical treatments required: oxygen
therapy (36 patients) held nebulizer treatments (26 patients), IV fluids (24
patients) and EKG's (17 patients).
Reasons to call the R-Team: bedside nurse concern - 44% of the time,
systolic blood pressure less than 90 - 23% of the time, declining oxygen
saturation by pulse oximetry - 13% of the time, declining mental status - 6 %
of the time and increasing respiratory rate above 24 breaths per minute - 5%of
the time. About 60 % of the patients stayed in their acute care room, while 40
% were transferred to the ICU. We
compared the number of cardiac arrests from the previous year. It was noted
that in the October - December 2004 timeframe, there were 41 cardiac arrests in
the area covered by the R-Team. We
dropped that number to 22 from October to December 2005. This represents a 54 % decrease in cardiac
arrest procedures. No other change in practice was instituted at this
time.
Conclusion: The R-Team has proven its
success and will continue. We
continually assess the number of R-Team calls and responsibilities to insure
adequate coverage. Though the R-Team is
the primary responsibility of the operational supervisors, staff members may
respond to R-Team calls as needed.
Respiratory therapists and supervisors have initiated the R Team when
they have seen a patient in declining health conditions. The staff has embraced the R-Team concept for
emergent patient conditions. Plans are
currently being made to increase the R-Team to a 24-hour per day service.