Rapid Response Teams, Saving Lives through Collaboration… Successes and Lessons Learned by Kathleen Carey, RN, CNS-BC, CCRN Jodi Hamel, RN, CCRN

Rapid Response Teams Institute for Healthcare Improvement (IHI) in December 2004 launched the “One Million Lives” campaign recommending Rapid Response Teams (RRT’s) be placed in hospitals More than 3000 hospitals participated in the campaign 2005 RWJ funded “learning networks” for implementation IHI unveiled “Five Million Lives” campaign expansion in RRT’s were in more than1500 US Hospitals US News and World Report and the Wall Street Journal reported the potential benefit of RRT 2008 Joint Commission added NPSG 16A

Institute of Medicine Core Competencies Provide patient-centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Utilize informatics From Health Professions Education: A Bridge to Quality. Institute of Medicine, 2003

Purpose and Goals of RRTs Rapid response teams are expert clinicians who respond and provide interventional care to patients experiencing acute changes in their conditions. The goals of the team are to recognize early signs of patient deterioration and to prevent avoidable code events. IHI recommends a goal of 25 RRT calls per 1000 pt discharges or 10 calls per every 100 occupied beds

CVPH Rapid Response Journey Saving Lives through Collaboration CVPH is 341 bed non-profit community hospital Rapid Response Team (RRT) began in July 2005 Nurse Consultation Model, Lewin's Change and Watson's Caring Theory; theoretical framework Systems analysis and improvement RN empowerment Physician and staff education Response team consists of an ICU RN, RT, PCC

Jul-Dec '05

Jan-Oct '10 Jul-Dec '05

Promoting Nursing's Future The Nursing Consultation Model Reduction of inpatient codes (exclude ICU) Education through nursing consultation “Save of the Month” Implementation of family RR calls Collaboration of healthcare team Growth of consultation models

Promoting Nursing's Future A Bridge to Clinical Wisdom RR calls decrease transfers to HLOC Yearly education Admission brochure (Soarian) Annual Executive Board presentation Call early; call often Story telling at Hospital Practice Council Dynamic rapid response practice team

Lessons Learned Staff perceptions Resistance to change Physicians’ perceptions Delay in calling Clinical grasp Clinical inquiry Staffing Skilled know-how of coaching Newly hired staff/physicians Family RRT calls Unplanned transfers

Conclusions RRT widely accepted 8-12% reduction in codes outside ICU 13% increase in RR calls 74% of calls; patients remain in room 32/month unplanned transfers 75% of transfers are without RR call Senior leadership support Nursing consultation model growth Family initiated calls slow progress

Key Elements Clinical coaching with each call 3 C’s computer, chart, caller Embrace clinical inquiry “I need another set of hands” Invite senior leadership to “Save of the Month” recognition Family/patient education on admission Hardwire RRT process with ongoing education Perception awareness

Rapid Response Team Still Not Cutting It? RRT inconclusive; vigorous debate Chan et al, 2010