1. Catholic Medical Center Rapid Response Teams
Peggy Lambert RN, MS,MBA
Beatriz Jauregui RN, BS

2. IHI MOVE YOUR DOTTM SAVE 100K LIVES CAMPAIGN SBAR
Deploy Rapid Response Teams
SAVE 100K LIVES CAMPAIGN
Prevent Adverse Drug Events (ADE)
Prevent Central Line Infections
Deliver Reliable Evidence-based Care for AMI
Prevent Ventilator Associated Pneumonia
SBAR
Prevent Surgical Site Infections

3. Why Rapid Response Teams
Three fundamental problems often lead to failure to rescue:
Failures in planning
Includes assessments, treatments, goals
Failure to communicate
Patient-to-staff, staff-to-staff, staff-to-physician, etc.
Failure to recognize a problem

4. Clinical Instability Prior to Arrest
Warning signs within 6 hours of event:
MAP <70 or >130 mmHg
Heart rate <45 or >125 per minute
Respiratory rate <10 or >30 per min
Chest pain
Altered mental status
Franklin’s article identified several warning signs present within 6 hours of arrest. These warning signs are shown here.
Franklin C, Mathew J. Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22(2):
Cardiac arrests on the general wards are commonly preceded by premonitory signs and symptoms. Training strategies for nurses and physicians should include the need to devote special attention to patients discharged from ICU who are at greater risk of cardiac arrest.
Franklin. Crit Care Med. 1994;22:

5. CMC’s RRT Primary nurse Charge Nurse on unit
ICU Clinical Leader or charge nurse
Respiratory Therapist
Nursing Coordinator (off shifts)

6. Role of the team
RRT is not intended to take the place of immediate consultation with the physician if needed.
After consultation with the RRT, a call is placed to the appropriate physician. The intention is to help patients in the time of clinical instability and not to replace physician involvement in that process.

7. Role of the team Assess Stabilize Assist with communication
Educate and support
Assist with transfer to a higher level of care if necessary

8. SUCCESS STORIES
Among surgical patients, the deployment of RRT’s has been associated with a reduction in the incidence of respiratory failure, stroke, severe sepsis, and acute renal failure as well as a reduction in the number of ICU admissions, length of stay, and postoperative mortality.
CritCare Med ;32:

9. SUCCESS STORIES
Sites that have implemented RRT’s have reported a reduction in cardiac arrests and deaths, as well as a reduction in ICU and hospital bed stays among survivors of cardiac arrest.
BMJ ;324:

10. Catholic Medical Center
Rapid Response Team Update
January- December 2006

11. RRT Analysis Total RRT Calls Per month
We monitor number of calls per month and have seen a significant growth in the number of calls over the past 2 years
When we see a down trend in numbers we re-educate
Staff to remind them to think of the RRT
Post stickers with the RRT telephone number on phones

12. Code Blues
Increased number of Code Blue occurring in the ICU and decreased numbers occurring on the Med/Surg & Telemetry Units

13. RRT Occurrences
RRT calls occur most frequently between the hours of 8 PM to 7 AM
There are no patterns/ trends as to any particular day of the week

14. CMC’s experience follows the literature.
Precipitating Event
CMC’s experience follows the literature.
The majority of calls are respiratory related followed by cardiac then neurological events

15. Rapid Response Team Arrival
Average Rapid response team arrival is 4 minutes from initial call.

17. Disposition
Most patients were transferred to a higher level of care after RRT deployment- 48.6%
35.5% remain on their current unit with specific follow up identified
Unadjusted Mortality
We have observed a decrease in unadjusted mortality. With the number of concurrent quality improvement processes it is difficult to determine the exact role of the RRT in this, however we do believe that it has played a role in the decrease.

18. Rapid Response/ Code Correlation
38% Code Blue calls occurred outside of the ICU. Since the initiation of the RRT, Codes occurring outside of the ICU has decreased

19. Based on 50 consecutive Mortalities from 7/1/06- 9/30/06
CMC has used the IHI 2x2 Matrix to analyze 50 deaths by Comfort Care Type and Unit of Admission. This is helpful in determining right care, right nursing unit.
Based on 50 consecutive Mortalities from 7/1/06- 9/30/06
ICU Admit
Non-ICU Admit
Comfort Care
IHI Aggregate 3%
IHI Aggregate 13%
Non Comfort Care
IHI Aggregate 37%
IHI Aggregate 48%
IHI Aggregate- N- 64 acute care hospitals

20. IHI 2x2 Matrix Change Ideas
Box 1 suggestions:
Maintain pressure on the system to avoid inappropriate ICU admissions.
A discussion to understand the limits of care should occur on admission
Box 2 Suggestions:
Advanced Directives
Alternatives to hospital care at the end of life
Palliative Care Team
Community outreach for Advanced Directives
Box 3 Suggestions:
Glycemic Control
Sepsis Intervention
Ventilator Bundle
Coordination of care in the ICU by an Intensivist
Daily goal sheets
Communication and Handoffs
Central Line Bundle
Box 4 Suggestions:
Rapid response Team
Early Warning System
Multidisciplinary Rounds in the ICU
Central Line Bundle outside of the ICU
Advanced training for Rapid Response Team incorporating Sepsis and Early Warning