2007 OPEN FORUM Abstracts
DEVELOPMENT AND USE OF A MEDICAL STAFF APPROVED RAPID RESPONSE TEAM PROTOCOL
Background:BMH's rapid response team(RRT) was formed May 05. Composed of a charge respiratory therapist and a critical care charge nurse, the team responds to calls for help for non-arresting patients 24/7. Although discussed during team development, the RRT did not begin with protocols. It was soon apparent that waiting for physician call back to start interventions caused delays and risks. We hypothesized that having a protocol in place would accelerate interventions, and thus improve patient outcome.
Method: The Medical Staff approved a protocol for the Respiratory Department October 05. This is based on RT services performed at RRTs and independent RT calls, and includes guidelines for the use of each procedure. The protocol allows RTs to perform O2 Sats and ABGs, implement and titrate O2, order a chest xray and give a bronchodilator.The RT protocol is the template for the RRT protocol approved March 06. The RRT protocol duplicates the RT protocol but adds racemic epinephrine for stridor and NPPV for respiratory distress. Defined nursing interventions of IV insertion, NSS bolus, naloxone and nitroglycerin administration, obtaining labs, and performing cardiac monitoring are also included. Once initiated, the attending physician is called with actions and results. A completed protocol order form with interventions performed is placed in the patient chart, and a copy is sent to the Critical Event Committee for 100% retrospective review.
Results: The RRT protocol has been used at 82% of calls. The avg. visit is <15 minutes (pre-protocol was 16-45 min.), 41% of patients are transferred to a higher level of care (48% pre), and 59% are stabilized at the bedside(33% pre). Interventions include: O2 therapy - 82%, ABG and/or O2 Sats - 82%, Resp Rx - 14%, cardiac monitoring- 64%, labs - 12%, Xray-10%, and Meds/Fluid Bolus - 45%. There has been no documented physician concerns or adverse reactions associated with protocol use. Reviews of protocol-defined actions performed by the RRT have been found appropriate.
Conclusion: In the two years since implementation of the RRT, hospital mortality has decreased 23%(April 07) without any other significant change in patient care or population. The decrease in hospital mortality just after the protocol started was 15%(June 06). The use of a medical staff approved RRT protocol has streamlined emergent actions by decreasing delay in providing patient care and giving clearly defined guidelines for practitioners.