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.