The Science Journal of the American Association for Respiratory Care

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.  

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