Rapid Response Team RRT What is RRT A Team designed for early intervention for potentially unstable patients A Proactive approach to patient care Who makes up the RRT Varies Widely Nurses Respiratory Therapists Physicians (Attendings, Fellows & Residents)

Research Findings Majority of patients who arrest in the hospital have signs of deterioration for 6-8 hours Saves Lives Reduces LOS Calls for RRT’s doubles after the 1st year implementation 30 % decrease in cardiopulmonary arrests in one documented study. Approximately 40 % of patients survive to discharge following RRT activation

Research Findings cont’d Expedites DNR decisions in appropriate cases Often only simple interventions needed One of 8-1600’s RRT calls found a patient was on 3x’s glucophage, admission was avoided with medication adjustment Facilitates staff education

Suggested Criteria for Initiating RRT Evidence-based literature findings: Initial call should be made to appropriate covering physician or team prior to initiating RRT call Staff member worried about the patient Inadequate or untimely response from covering team

Criteria cont’d Acute Change in: Heart Rate <40 or > 130 SBP < 90 mm Hg RR <8 or >30 O2Sat <90 Mental Status (LOC) UO < 50 ml/hr

Top 5 Interventions for RRT Calls Oxygen therapy Non-invasive positive pressure ventilation by mask or ventilator Nebulizer treatments IV fluid bolus required Lasix administered

Potential Economic Benefit Conservatively ICU care costs $2,000-$3,000/day If 10% of admissions avoided and 10% of those patients admitted to ICU have shortened LOS’ we would save 5,500 ICU days. Results in $11,000,000 savings Opens up additional ICU beds for patients requiring admission. Facilitates more timely admissions from the Floor, ED, PACU and outside transfers

MICU RRT Experience MICU Responders Charge Nurse Resident (Fellow/Attending) Started July 2003 on 2 units, gradually increased to 6 units (medical) From July 2003-May 2004: 24 calls, 15 admissions (42.4% saved ICU admissions) 57.6% of patients admitted after a RRT response had 1.4 days less ICU LOS

MICU Experience cont’d Top 3 Primary events for calls made: Respiratory Distress Hypotension Change in LOC Time Investment: 10-60 minutes per call

Rapid Response Team 1 Staff Education 2 RRT Model modified/Education 2

Barriers Late Calls…near arrest Units initially hesitant to call for help Concern about floor physician/ICU physician conflict Floor nurses concerned about “going over someone’s head” Limitation of resources…using stressed resources Documentation of event No documentation from requesting units Inconsistent documentation from responders

PLAN Modify RRT Model Educate Collect Data Evaluate and Report Responders are now ICU Charge Nurse and Respiratory Therapy Supervisor. Attending/Resident/Fellow/NP will respond when appropriate and requested by the RRT Educate RRT Presentation to Leadership and Staff Collect Data Ongoing collection Analyze and track trends Evaluate and Report Effectiveness of RRT Barriers Patient outcomes