2006 OPEN FORUM Abstracts
Results of a four-month rapid response team (rrt) pilot study.
Michael
R. Jackson, RRT-NPS, CPFT, Paul F. Nuccio, RRT, FAARC, Sarah Mortell,
RRT, Marie Duggan, RRT. Department of
Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts.
Introduction: The Rapid Response Team is a small group
of clinicians who bring critical care expertise to the patient's bedside (or
wherever it is needed). The RRT is one
of the interventions recommended by the Institute for Healthcare Improvement
(IHI) as part of their 100K Lives Campaign.
Most rapid response teams are comprised of a Registered Respiratory
Therapist, a Critical Care Nurse, and a Physician. The introduction of Rapid Response Teams has become
popular nationwide over the past couple of years.
Hypothesis: The use of a Rapid Response Team may result
in a reduced need for patient transfer to the Intensive Care Unit (ICU), and a
reduction in cardio-pulmonary arrest requiring emergency resuscitation
procedures.
Methods: Specific criteria for initiating a request for RRT
activation were developed, followed by extensive staff education in the areas
where the pilot would take place. Small, laminated pocket cards were
distributed to the staff as reminders of the specific criteria. Staff were also encouraged to activate the
RRT if they were just "worried about the patient".
Results: During the four-month trial period, a total of 104
calls were placed to the RRT.
Approximately half of the calls (48%) were registered during that day
shift, with the other half split between the evening (25%) and night (27%)
shifts (Fig. 1). Approximately 46% of
the calls involved the presence of one or more criteria that was directly
respiratory-related (Fig. 2). Team
interventions that took place as a direct result of the RRT activation included
non-invasive positive pressure ventilation (NPPV), increased oxygenation, fluid
resuscitation, and imaging studies (Fig. 3).
ICU transfer was avoided in 66% of the patients, while transfer of other
patients to an ICU was accomplished expeditiously.
Conclusion: The Rapid Response Team concept provides
expert assessment and early intervention, allowing time to ask questions and
formulate plans, unlike that which occurs in a cardiac arrest scenario. The role of the respiratory therapist is
critical as part of the RRT. Due to the
potential benefit of NPPV for many of these patients, a decision was made to
keep a non-invasive ventilator available in all areas serviced by the RRT, allowing
for the immediate implementation by the respiratory therapist.
