2006 OPEN FORUM Abstracts
Results of a four-month rapid response team (rrt) pilot study.
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.