1. 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)

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. 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

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

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

11. 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

12. 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