2006 OPEN FORUM Abstracts
THE ESSENTIAL ROLE OF THE RESPIRATORY CARE PRACTIONER IN A RAPID RESPONSE TEAM
Laurie Tamminga RRT, Colleen
Chase RN, Diane Wehby RN, Karen Burritt RN, Saint Mary's Health Care-a member
of Trinity Health, Grand Rapids, Michigan
Background: Saint Mary's Health Care is a
330 bed urban teaching hospital. Based on historical data, we identified an
opportunity to improve mortality and morbidity rates in patients at risk for
clinical deterioration outside of the intensive care unit (ICU). It was our aim
to prevent or provide early intervention for patients who are becoming unstable
outside of the ICU.
Method: Using the template of a CPR
team, a Rapid Response Team (RRT) was created to respond immediately to medical
emergencies throughout the hospital. An aggressive 30-day implementation time
line was established. The RRT consists of an experienced Registered Respiratory
Care Practitioner (RCP) and an ICU Registered Nurse (RN). The process is
activated via a direct phone call or overhead page. The RRT works in conjunction
with the patient's current medical and nursing team to implement care whenever
possible. The services of a medical intensivist are available as necessary. The
RRT provides protocol-driven first line emergency treatment for patients in the
absence of a physician. The RRT quickly brings to the bedside clinical experts
who assess and provide the appropriate level of care. A database was developed
to track all rapid response events. Weekly case reviews were conducted to track
and identify opportunities for improvement.
Results: In the first year of
implementation, the RRT responded to over 1,300 calls for assistance.
Approximately fifty percent of all RRT calls were for respiratory problems
including airway, oxygenation or ventilation management. Of these calls for a
primary respiratory problem, one-third of the patients required non-invasive or
mechanical ventilation. Over the course of implementation, a 40%
reduction in case-mix index adjusted adult (non-psychiatric) mortality rate was
demonstrated. In addition, unplanned ICU admissions have decreased by 10-15 per
month. The number of cardiac arrests occurring outside of the ICU has decreased
by nearly 50%. Cost avoidance dollars were estimated at approximately 1.5
million dollars over one year.
Conclusion: The RCP is an essential member
of the RRT. The RCP is uniquely qualified to provide advanced assessment
skills, initiate bronchodilator therapy, quickly obtain arterial blood gases
with electrolytes/lactate levels, titrate oxygenation, and begin ventilatory
assistance. The decrease in cardiac arrests, unplanned ICU admissions, and
overall case-mix adjusted mortality rates resulted from the RRT's pro-active
process which allowed for early identification and initiation of treatment for
impending ventilatory/respiratory failure, tachycardia, sepsis, heart failure
and hypotension, etc. The process that allows all practitioners to call the RRT
for assistance has empowered front line associates to request additional help
before a crisis leads to cardiac arrest.