The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts


R. E. Graham1, M. J. Hewitt1, J. Amos1, F. Zhong1, J. McCarthy1

Background: In 2005, the Institute for Healthcare Initiative (IHI) launched the “100,000 Lives Campaign”. A key concept of this initiative was for the provision of care to prevent adverse events outside of the Intensive Care Unit (ICU). An integral recommendation is for development and implementation of Rapid Response Teams (RRT) [1, 2]. This based in part on successes reported by facilities in Australia [3], as well as other facilities [4,5]. Memorial Hermann-Texas Medical Center (MH-TMC), a 949 bed Level I Trauma Center affiliated with the University of Texas-Houston Medical School pledged to the campaign. Respiratory Care Services took the lead on the project, educating Hospital/Medical staff. The RRT was implemented in January 2006, and is staffed with a Respiratory Therapist and a Critical Care Nurse. Additional support is available as required. Of note, the team was staffed entirely by respiratory therapists for the first 10 months due a nursing shortage. Stroke and Sepsis screens are part of the workup.

Methods: A retrospective review of statistical logs of both the RRT and the Code Team, covering the period of January-December 2006 was conducted, looking specifically for Floor Codes, Transfers, and Mortality.

The MH-TMC RRT responded to 470 calls in 2006 (Jan 21 –Dec 31; 1.8 calls per day, on average) and effected the transfer of 269 patients (66% of the total) to a higher level of care within the facility. Of incidental note, only 12 (approximately 2%) of the calls received were “non-interventional”. An 18% decrease in floor mortality was realized, as was a 56% reduction in floorcCodes (from 90 in 2005 to 56 in 2006).

Conclusions: Our experience has been entirely positive, from the positive patient outcomes noted to the level of support received throughout the institution. Our initial data closely mirrors that of Bellomo, et al. in Australia, and supports the IHI Rapid Response Team recommendation(s). RRT data reporting is a component of the Performance Improvement program. Ongoing data analysis will occur to ensure that these findings are supported over time.

[1] Institute for Healthcare Initiative, “100,000 Lives” Campaign:
[2] Findings of the first consensus conference on medical emergency teams. Devita MA, Ballomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Crit Care Med 2006;34(9):2463-2478.  Erratum in: Crit Care Med 2006;34(12):3070.
[3] A prospective before-andafter trial of a medical emergency team. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. Med J Aust 2003;179(6):283-287.
[4] Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, et al. Crit Care 2005;9(6):R808-R815.
[5] Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL; Medical Emergency Response Improvement Team (MERIT). Qual Saf Health Care 2004;13(4):251-254.