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CoverArticle CE Continuing Education

Rapid Response Team


Challenges, Solutions, Benefits
Kim Thomas, RN, BSN
Mary VanOyen Force, RN, BSN, CCRP
Debbie Rasmussen, RN, CMSRN
Dee Dodd, RN, BSN
Susan Whildin, RN, BSN, CNRN

A current challenge facing


hospital administrators is how to
manage healthcare workers and
In 2004, in its 100000 Lives
Campaign, the Institute for Health-
care Improvement (IHI) encouraged
available resources so as to achieve American hospitals to implement
the best possible patient care and rapid response teams (RRTs). The
outcomes. Increasing acuity levels use of RRTs was 1 of 6 lifesaving
of patients, rapid admission and strategies recommended by the IHI * This article has been designated for CE credit.
A closed-book, multiple-choice examination fol-
discharge cycles, and the national to improve patients’ outcomes; all 6 lows this article, which tests your knowledge of
the following objectives:
shortage of nurses make it difficult strategies were backed up by solid
to provide high-quality care at the evidence in the medical literature. 1. Identify 3 fundamental problems leading to
failure to rescue
bedside.1 Failure to recognize changes The national media focused on 2300 2. Describe the challenges in establishing a
in a patient’s condition until major healthcare organizations that joined rapid response team
3. Discuss benefits of a rapid response team in
complications, including death, have together to implement the strategies; terms of patient care
occurred is referred to as failure to today these strategies have become
rescue. That phrase is not intended an established standard of care.6
to imply negligence or wrongdoing.2-5 According to the IHI, as of June 2006,
Failure to rescue is a measure of the an impressive 122300 lives had been
overall performance of a hospital saved since the implementation of Authors
with respect to caregivers’ ability to evidence-based interventions in 2004.
All authors are employed by Delnor-
recognize and react autonomously Hospitals are currently implementing Community Hospital in Geneva, Ill.
to postoperative complications such RRTs as a proven strategy for pre-
as bleeding, pneumonia, or sepsis. venting avoidable deaths of patients.7 Corresponding author: Kimberly Thomas, Team
Leader, 2 West, Critical Care, Delnor-Community
The early signs and symptoms of An RRT is intended to prevent Hospital, 300 Randall Rd, Geneva, IL 60134
(e-mail: kim.thomas@delnor.com).
deterioration in a patient’s condition deaths outside the intensive care unit
To purchase electronic or print reprints, contact The
may not be recognized by staff or may (ICU) by providing a resource team InnoVision Group, 101 Columbia, Aliso Viejo, CA
be acted upon too late to improve the that can be called to a patient’s bed- 92656. Phone, (800) 809-2273 or (949) 362-2050
(ext 532); fax, (949) 362-2049; e-mail,
patient’s outcome. side 24 hours a day, 7 days a week. reprints@aacn.org.

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The RRT is expected to foster collab- ing status.10 Hospitals have established Magnet hospital in the Chicago area,
oration between critical care nurses evidence-based criteria to facilitate began implementation of an RRT by
and medical-surgical nurses in the early identification of physiological organizing an interdisciplinary rapid
care of patients through assessment, deterioration in both adult and response steering team. This project,
communication, immediate inter- child patients. These guidelines help along with participation in the IHI’s
ventions, support, and education. novice staff members determine if national Save 100000 Lives Campaign,
A patient’s baseline condition an RRT should be called for a bed- was approved by the hospital’s per-
begins to deteriorate a mean of 6.5 side consultation.11 formance improvement quality com-
hours before an unexpected critical Nurses must be aware of signs mittee. A nurse and a physician
event or actual cardiac arrest.8 Seventy and symptoms that could lead to served as chairpersons for this proj-
percent of such events are preventa- cardiopulmonary arrest, or a “code ect. Steering team members included
ble.7 Early recognition of warning blue.” The condition of a patient 6 nursing leaders, 4 ICU staff nurses,
signs of clinical deterioration and before a cardiac arrest can be recog- 3 respiratory therapists, and the chief
interventions by an RRT may pro- nized by staff, and early interven- nursing officer. Weekly meetings
vide better outcomes for general tions can be initiated to prevent a were planned with the goal of launch-
medical-surgical patients. Buist et al8 code blue. When nurses are provided ing the new RRT within 5 months.
reported that RRTs resulted in a 50% with an RRT and are on the alert for The project’s steering team formu-
reduction in the occurrence of cardiac potentially dangerous scenarios, lated action plans to accomplish the
arrest outside the ICU. In another patients’ deaths may be prevented. following:
study of RRTs, Bellomo et al9 reported Preventing a code blue should be a • Review current evidence-based
that postoperative complications top priority for nurses in medical- practice
requiring transfer to the ICU were surgical units because the survival • Establish an RRT structure
reduced by 58%, and postoperative rate to discharge after a full cardiopul- • Evaluate the skill level of the
deaths were reduced by 37%. RRTs monary arrest is only 15%.12,13 Antici- responders
may also decrease the number of pation of code blue situations involves • Establish criteria for when to
unnecessary transfers to a higher early recognition of vital signs before call the RRT
level of care by a mean of 30% and cardiac arrest, awareness of trends • Create documentation and
decrease overall hospital mortality in the patient’s status, activation of data collection tools
by a mean of 26%.9 an RRT, and nurse-to-nurse collabo- • Measure results
RRTs may consist of different ration before it is too late to prevent • Provide education throughout
structured groups: physician and a death.14 the institution
nurse, intensivist and respiratory Three fundamental problems • Deploy program pagers
therapist, physician assistant alone, lead to failure to rescue in hospitals: • Develop feedback mechanisms
critical care nurse and respiratory (1) breakdown of communication • Provide ongoing education for
therapist, or clinical specialist alone.7 between patients and staff (any responders
The RRT may be called upon at any caregiver), between staff and other The RRT consisted of 1 critical
time that a staff member becomes staff, between staff and physician, care nurse and 1 respiratory therapist
concerned about a patient’s condition. and/or between physician and who were assigned to in-house call
Physiological changes such as changes physician; (2) failure to recognize 24 hours a day, 7 days a week. Pagers
in heart rate, systolic blood pressure, early signs of deterioration in a were programmed with an easy-to-
respiratory rate, pulse oximetry sat- patient’s hemodynamic condition; remember number (7999) so that
uration, mental status, or urinary and (3) incomplete assessments or staff members could type in the
output can be gradual or sudden.9 inadequate treatments.15 patient’s room number directly.
Changes in significant laboratory Criteria were developed to determine
values such as sodium, glucose, and Implementation of an RRT when the staff should page the RRT.
potassium levels could also be early Delnor-Community Hospital, a The ICU nurse and respiratory ther-
indicators of a patient’s deteriorat- 128-bed, nonteaching acute care apist would be expected to arrive at

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the patient’s bedside for a consulta- in the medical-surgical units and ing physicians were always notified
tion within 5 minutes of being paged. ICUs, respiratory therapists, and by telephone of an RRT call involv-
The nursing supervisor and nurse physicians. ing their patients. Findings based on
chairperson of the RRT steering team The project’s steering team col- physical assessment were documented
were also included in the page to laborated with the physicians to immediately after the RRT consulta-
promote communication among develop a protocol that would be ini- tion, as was the transfer of the patient
staff and to provide backup support. tiated once the RRT was activated. to a higher level of care if needed.
Hospital staff and physicians were The primary role of the RRT was to The patient’s status was documented
taught an effective communication collaborate with the staff nurse at again during a follow-up visit 8 hours
technique called SBAR (situation, the patient’s bedside to determine if after the initial RRT consultation.
background, assessment, recom- further interventions were needed. The RRT chairperson was responsi-
mendations) to promote efficient Diagnostic tests were incorporated ble for compiling the data for each
reporting skills. By using a uniform into a protocol so that the RRT could patient and for tracking the patient’s
communication technique, staff initiate 5 interventions on their own status until hospital discharge.
members were able to report their before speaking with the primary An essential component of the
findings directly and in a concise physician. Types of interventions success of an RRT was a comprehen-
sive and detailed communication
“being worried about a patient” or plan to convey the purpose and goals
of the RRT to physicians, adminis-
“having a gut feeling” were legitimate trators, clinical staff, and nonclinical
reasons to call the RRT staff. Hospital newsletters, physician
newsletters, medical staff meetings,
board of directors meetings, and fre-
manner, providing the physician included arterial blood gas analysis, quent leadership and staff commu-
with clear information about the chest radiography, electrocardiogra- nications provided ongoing education
patient’s condition, history, assess- phy, oxygen per protocol, and/or tests for 2 months before and after the
ment, and recommendations. to check blood glucose levels. The RRT initiative was launched. On
The project’s steering team results from these interventions were May 1, 2005, the RRT was ready to
developed a set of criteria for deter- then communicated to the physician go live. Engagement of all staff and
mining when an RRT should be called to provide a more detailed assessment physicians was essential to the suc-
in to consult on a medical-surgical of the patient’s current status. cess of the program. Members of the
patient. These criteria, known as Key indicators were tracked in a RRT proudly wore personalized
activation criteria, were simple and database to measure patients’ out- white jackets with the newly designed
unrestricted; they included concern comes before and after implementa- RRT logo (Figure 1). The ICU nurse
about the patient among staff mem- tion of the RRT. Information on every
bers and/or changes in the patient’s RRT call was collected on a standard-
heart rate, heart rhythm, blood pres- ized form through the computerized
sure, respiratory status, or mental documentation system. This nursing
status. No call would be considered documentation became a permanent
inappropriate. Intense education part of the patient’s medical record.
throughout the hospital provided Information collected included
reassurance to nurses that “being patients’ demographics, location,
worried about a patient” or “having reason(s) for the call, call start time,
a gut feeling” were legitimate reasons call end time, and narratives format-
to call the RRT. Education was ongo- ted as SBAR (situation, background,
ing and stressed the importance of assessment, and recommendations) Figure 1 Logo for the rapid response
team at Delnor-Community Hospital.
mutual respect between the nurses for the primary physician. Attend-

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and respiratory therapist assigned to Once the criteria and benefits had • Doing rounds of all medical-
the RRT visited all units to inform been developed, applications were surgical units every 2 hours to address
staff members and physicians of sent to all members of the critical questions or concerns of staff
the purpose and goals of the team. care and respiratory therapy depart- • Decreasing incidental overtime
Brightly colored stickers were placed ments. Applicants were interviewed • Performing other duties as
on all telephones and bulletin boards and selected by coordinators. Case assigned
to remind staff members of the acti- scenarios were used during the inter- At the start of the program, mem-
vation number. view process to determine the assess- bers of the project’s steering team
The project’s steering team trained ment and communication skills of were rotated so that someone would
staffing coordinators for the critical each applicant. always be available to the RRT by
care nursing and respiratory teams. After selection, RRT responders phone or pager. If team members
The role of the staffing coordinators participated in ongoing educational had any questions, they could con-
was to supervise and manage the sessions to strengthen the team’s tact the on-call member of the pro-
RRT staff and schedule. Their duties clinical competency. RRT charting ject’s steering team for clarification.
included interviewing candidates, screens were developed in the com- This support process continued for
scheduling staff, and assisting with puterized documentation system to 2 weeks and was reimplemented as
implementation of the program. reflect the SBAR technique with feed- needed when new members were
The coordinators developed a job back from the responders. Practice brought onto the team.
description for the RRT responders sessions were held to allow the A major benefit of the RRT pro-
and established qualifications for responders to become familiar with gram was the general improvement
the role. Qualifications included a accurate documentation and cus- it brought about in the hospital’s
minimum of 2 years of critical care tomer service skills. Training ses- culture as a result of the greater
experience. Communication skills sions focused on active listening emphasis on collaboration between
were essential to garnering support skills, critical thinking, and problem staff members and physicians. Pro-
for the project from nurses in the solving. Ongoing monthly training fessional respect increased between
medical-surgical units. Communi- and education sessions were planned critical care nurses, respiratory ther-
cating with bedside nurses in an as an important component of apists, and nurses from the medical-
effective and nonthreatening manner building a high-performing RRT. surgical units. Bedside collaboration
also was essential. The extra staffing hours required allowed staff members to teach one
The project’s steering team pro- for the commitment to a new team another about patients’ diagnoses
moted the professional benefits of were not planned in the ICU budgets. and treatments. Improved commu-
becoming a member of the RRT: Leaders and staff debated the RRT nication between physicians and
• Professional growth and recog- nurse’s role, the assignment of nurses and respiratory therapists
nition while promoting patients’ safety patients, and budget constraints. RRT was another benefit. Effective com-
• Designation as an RRT member responders working the day shift were munication was enhanced by the
through newsletters and hospital not assigned to patients. Responders SBAR communication system. Edu-
media working the evening and night shifts cation of nursing staff about the cri-
• Responsibility for an essential were given “light” patient assign- teria for activating the RRT, use of
role in the success of the IHI’s ments, defined as either 2 telemetry SBAR communication to report,
100000 Lives Campaign patients or 1 stable intensive care and assertiveness and teamwork
• Visibility as a member of the patient. Other duties for RRT mem- promoted rapid yet nonthreatening
RRT by wearing an attractive per- bers included the following: assessment of patients whose condi-
sonalized jacket • Doing rounds with discharge tion was deteriorating.
• Collaboration with multidisci- planner and primary nurse to assess Physicians were positive about
plinary teams within the hospital progress the RRT program because they per-
• Recognition of members’ spe- • Facilitating RRT responders’ ceived improved competence at the
cialized knowledge continuous education bedside as well as stronger cohesive-

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ness among staff members. Nurses, mary patients. In a cooperative effort, Group meetings were held to pro-
especially during their “off ” shifts, 2 critical care units worked together mote staff cohesion and to stress the
were grateful for opportunities to to decide who would serve as backup importance of the RRT in increasing
brainstorm with other staff members for RRT calls when the other unit patients’ safety.
about possible reasons why a patient was unavailable. Secondary support Scheduling of the RRT was very
might be “just not right.” Inexperi- was defined according to acuity lev- challenging. In the first 90 days, it
enced staff members and recent els by using telemetry nurses, emer- was necessary to schedule overtime
graduates found the RRT resource to gency department nurses, or hours for nurse leaders and clinical
be especially valuable. Bedside col- nursing supervisors. staff because of the high number of
laboration with experienced ICU RRT staff members were assigned inexperienced ICU nurses. It was
nurses and respiratory therapists specific duties and were given fewer essential to continually develop ICU
provided them with confidence and patients to care for. During the early staff to meet the qualifications to
a feeling of security. implementation phase, the ICU staff become an RRT responder. During
The attitude that a staff mem- perceived a discrepancy between dif- the first 90 days of RRT implementa-
ber’s concern about a patient was a ferent nurses’ interpretations of tion, an extra day-shift nurse with no
genuine reason to activate the RRT these roles. Interpersonal conflicts assigned patients was assigned to the
was pervasive in the organization emerged between staff members RRT. The cost of staffing evening-
and encouraged timid nurses to seek about their roles and responsibilities and night-shift workers increased
out consultations. The RRT slogan in the unit and on the RRT. It became only minimally because RRT workers
“Call Early . . . Call Often” was fre- apparent that different levels of pro- were assigned fewer patients. Over-
quently e-mailed to staff to encourage fessional motivation affected how time staffing was necessary only
participation in this new initiative. staff members used their time when occasionally during these shifts, when
The ICU staff and respiratory thera- they weren’t responding to an RRT staffing or acuity patterns required
pist gained a new respect for the acu- call. This variation in the level of changes to the RRT schedule.
ity of patients and for the workload of professional motivation caused dis- The initial startup required men-
nurses in the medical-surgical unit. cord among the nurses. The environ- toring and increased staffing levels
The mutual respect among healthcare ment became tense and apprehensive to adjust for the learning curve.
workers contributed to the success of during this initial phase of RRT After this initial period, ICU staffing
the RRT program. After each RRT call, implementation. returned to normal levels, which are
staff members were provided with an Effective communication and based on patients’ acuity. The RRT
evaluation form to express their opin- consistent strong leadership were assignment was integrated into the
ion about the experience. The evalua- essential during the initial imple- ICU nurses’ regular responsibilities,
tion forms were sent to the RRT mentation period. It was important much like a code blue assignment,
steering committee to be included to obtain acceptance from staff and did not require further increases
as feedback in the educational ses- members and to clarify the roles and in staffing. After 90 days of initial
sions for the RRT responders. duties of the members of the RRT. startup, no additional costs accrued
Staff meetings were held each month to the organization for the 24-hour-
Challenges to give the nurses a chance to discuss a-day, 7-day-a-week operations of
Acceptance of their new RRT their conflicts and explore possible an RRT.
roles was a challenge for ICU nurses, solutions. A culture change within
who were concerned about “aban- the ICU was required in order for the Costs and RRT Financial
doning” their own patients to respond ICU nurses to accept routine daily Benefit Model
to an RRT call from a nurse in the collaborations with medical-surgical In addition to the operational
medical-surgical unit. It was essen- nurses about patients in the medical- benefits of using an RRT, a financial
tial to reassure ICU nurses that surgical units. Staff members were benefit also accrues. The hospital
backup support would be available encouraged to give their feedback experiences significant cost reductions
to ensure the safe care of their pri- and suggest ways to improve the RRT. by avoiding unnecessary transfers to

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Calculating the annual cost savings of having a rapid response team (RRT) available 24 hours a day, 7 days a week

Using Managerial Labor and Cost Accounting System


Rapid Response Team Financial Benefit Calculator
Key Indicator Formula Amount
A Annual number of cases benefiting from RRT Input data 122
B Codes before RRT implementation per year Input data 12
C Codes after RRT implementation per year Input data 6
D Costs per code Input data $1000
E Potential saving in cost of codes per year (B - C)x D $6000
F Mean length of stay in medical-surgical unit, days Input data 3.8
G Mean length of stay in intensive care unit, days Input data 3.5
H Decrease in number of transfers to intensive care unit per year since RRT was implemented Input data 24
I Fewer days in intensive care unit due to decrease in transfers GxH 84
J Cost of bed in medical-surgical unit Input data $810
K Cost of bed in intensive care unit Input data $1970
L Cost of a transfer to higher level of care K-J $1160
M Annual cost of RRT Input data $0
N One-time costs of implementing RRT Input data $2000
O Mean length of stay of candidate for RRT call, days Input data 10.5
P Costs of patients who could have transferred to intensive care unit without RRT IxK $165 480
Q Potential annual savings due to RRT E+P $171 480

the ICU, cardiopulmonary arrests, organization’s financial savings of transfers from the medical-surgical
and complications that cause longer $171480 per year was calculated by units to the ICU were decreased by
stays in the hospital. The process of using labor and cost accounting 10%. Because of early interventions,
patient care involves multiple staffing methods (see Table). 63% of all RRT patients remained in
interactions and a complicated the medical-surgical units and did
application of caregivers’ knowledge, Impressive Results After not require a change in the level of
skills, expertise, technology, supplies, 16 Months care (Figure 4). Overall, only 2% of all
and medications. Patient care is not According to data reported in RRT patients experienced a code
one single intervention or a series of 267 patients (Figure 2), use of RRTs blue event during their hospital stay.
isolated events. The RRT initiative during a 16-month period resulted Although RRT patients had a mean
helps to keep patients on track to in a 56% reduction in the monthly stay of 10 days, which implies a high
ensure that they will have a timely rate of code blues in medical-surgical clinical acuity level, the total survival
discharge. The financial impact of units (Figure 3). In 2006, the mean rate at discharge was 86%.
RRT programs on healthcare organi- number of code blues outside the The RRT steering team collects
zations will become apparent in ICU, emergency department, and data on an ongoing basis and dis-
time, but this impact must be viewed operating room per 1000 discharges tributes monthly reports within the
in light of RRTs’ immeasurable bene- each month was 0.63, a decrease organization. Data collected on loca-
fits to patients and their contribution from 1.22 in 2005. Unanticipated tion, shift, day of the week, and
to the overall decline in hospital
mortality and morbidity.
40
This RRT financial benefit model
No. of calls

30
quantifies costs savings with the 20
general assumption that improving 10
quality increases the number of 0
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patients who can receive care, reduces


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patients through the patient care


system with no change in total cost.16
Figure 2 Total calls for rapid response team from May 2005 through August 2006.
The conservative estimate of the

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(7%), and implementation of a
3
hypoglycemia or hyperglycemia
No. of codes

2 protocol (3%).
1 These results show that reducing
the frequency of failure to rescue was
0
a benefit of an effective new RRT.

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monthly analysis to provide feed-
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Figure 3 Total number of code blue calls outside of the intensive care units and of the RRT team. Educational ses-
emergency department from May 2005 through August 2006. sions are organized for staff growth
and development.
100%
% of patients

Summary
50%
It is difficult to measure the num-
0% ber of lives that have been saved since
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the implementation of RRTs. Dr Don
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Berwick, president and chief execu-
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tive officer of IHI, stated, “The names


of the patients whose lives we save
Figure 4 Patients seen by the rapid response team who remained in the medical-
surgical unit: May 2005 through August 2006. can never be known. Our contribu-

triggers to activation assist in evalu- Figure 5). RRT 60%


ating staffing levels for the RRT and nurses’ interven- 50%
% of calls

the medical-surgical units (Figure 5). tions that were 40%


30%
In the past year, the RRT had a total started at the
20%
of 267 calls with a mean of 18 calls bedside during 10%
per month. The activation call times the call included 0%
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shifts, with the greatest number (Figure 6):


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occurring during the 3 PM to 11 PM implementation


bl

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shift (41%). Surprisingly, more RRT of an oxygen


re

calls (18%) occur on Wednesdays protocol (63%), Figure 5 Most common reasons that nurses in medical-surgical
units called the rapid response team to a patient’s bedside.
than on other days, but the calls electrocardiog-
were fairly evenly distributed across raphy (29%), Nebulizer
the week. The mean duration of an arterial blood Chest radiography
Furosemide
RRT consultation at the bedside was gas analysis
30 minutes; consultations lasted (23%), checking Electrocardiogram Arterial blood
from a maximum of 1 hour 57 min- of blood sugar gas analysis
utes to a minimum of 9 minutes. level (16%), chest
Blood
Many times, staff reported more radiography glucose check
than 1 reason for activating an RRT: (21%), adminis-
a staff member was concerned about tration of
the patient (50%) or the patient had furosemide Oxygen protocol
a change in respiratory status (45%), (8%), treatments Figure 6 Interventions used by rapid response team during
mental status (24%), heart rate or with a respira- bedside call (mean percentages): May 2005 through August
rhythm (14%), or blood pressure (12%; tory nebulizer 2006.

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tion will be what did not happen to
Case Study
them.”17 The hospitalwide operational
and financial benefits of implemen- An 87-year-old woman with a history of atrial fibrillation and congestive heart fail-
tation of an RRT greatly outweigh ure was admitted to the hospital with dyspnea. On assessment, her medical-surgical
bedside nurse found that the patient had a heart rate of 160/min, a respiratory rate of
the challenges of starting up an RRT.
30/min, and an oxygen saturation of 90% on room air. The patient had an initial chest
Benefits include improved safety of radiograph that showed ventricular enlargement and an echocardiogram that showed
patients, shorter hospital stays, fewer enlarged ventricles, mitral valve prolapse, and an ejection fraction of 0.32. A myocar-
code blues, fewer transfers to the dial infarction was ruled out, and the patient was worked up for pneumonia and wors-
ening congestive heart failure.
ICU, increased awareness and identi- The patient’s medications included 180 mg diltiazem hydrochloride daily, 10 mg
fication by nurses of signs and symp- enalapril maleate twice daily, 40 mg furosemide twice daily, metoprolol succinate, and
toms leading to deterioration in a warfarin sodium. Within 3 hours after assessment and initial workup, the medical-
patient’s condition, decreased mor- surgical bedside nurse activated the RRT because she was concerned that her patient
was symptomatic with a heart rate of 160/min. Within 5 minutes, both a critical care
tality and morbidity, increased satis- nurse and a respiratory therapist arrived to assess the situation. They found the
faction of physicians with nurses, patient lying in bed; her skin was red, and she was awake and complaining of tightness
increased satisfaction of patients in her chest. The patient’s electrocardiographic rhythm via telemetry showed atrial fib-
rillation at a rate of 160/min. Her body temperature was 36.6ºC (97.8ºF), her pulse was
with their care, and increased job
109/min, her respirations were 27/min, and her blood pressure was 136/69 mm Hg.
satisfaction among nurses. Develop- The RRT initiated the oxygen protocol and obtained an electrocardiogram. The
ing a structured RRT for patients’ patient’s vital signs remained stable with a pulse of 130/min, respirations of 25/min,
safety empowers all staff to operate and a blood pressure of 126/76 mm Hg.
The medical-surgical bedside nurse called the cardiologist and used the SBAR
at a higher competence level. Most technique to report her findings. The cardiologist ordered 40 mg furosemide, 0.25 mg
nurses have an intrinsic desire to digoxin now and with the dose repeated in 6 hours, and 5 mg metoprolol tartrate. The
function at a higher level. RRTs are RRT used the opportunity to educate the nurse about atrial fibrillation, the signs and
nurse-driven, self-directed, and self- symptoms associated with this condition, and the treatment needed to control the
rhythm.
managed working teams that pro- The patient stayed in the telemetry unit and did not need to be transferred to the
mote patients’ safety and efficiency next level of care. Eight hours after the initial RRT consultation, a follow-up visit was
within the hospital (see Case Study). made by the RRT. The patient was found sitting up in bed having breakfast without
complaints. The patient was treated for congestive heart failure and discharged back
Acknowledgment to the nursing home 1 week later. This RRT call prevented an unnecessary critical care
We gratefully acknowledge Keith Gordey, MD, for his pas- admission and encouraged collaboration among nurses.
sion for providing evidence-based patient care and
Richard Roxworthy for his financial expertise.

References
1. Rogers A, Wei-Ting Hwang S, Aiken L, medical emergency team on reduction of 14. Ashcraft A, DiAgnostino A. Differentiating
Dinges DF. The working hours of hospital incidence of and mortality from unexpected between pre-arrest and failure-to-rescue.
staff nurses and patient safety. Health Aff cardiac arrests in hospital: preliminary Medsurg Nurs. 2004;13:211-216.
(Millwood). 2004;23:202-212. study. Br Med J. 2002;324:387-390. 15. Simmonds T. Best practice protocols:
2. Clarke S, Aiken L. Failure to rescue. Am J 9. Bellomo R, Goldsmith D, Uchino S, et al. implementing a rapid response system of
Nurs. 2003;103:42-47. Prospective controlled trial of effect of med- care. Nurs Manage. 2005;36:41-59.
3. Aiken L, Clarke S, Sloane DM, Sochalski J, ical emergency team on postoperative mor- 16. Ward WJ. The Business Case for Implementing
Silber JH. Hospital staffing and patient mor- bidity and mortality rates. Crit Care Med. Rapid Response Teams [PowerPoint presen-
tality, nurse burnout, and job dissatisfac- 2004;32:916-921. tation]. Available at: www.ihi.org/IHI/Topics
tion. JAMA. 2002;288:1987-1993. 10. Lee A, Bishop G, Hillman KM, Daffurn K. /CriticalCare/IntensiveCare/Tools/Business
4. Sochalski J, Aiken L. Accounting for variation The medical emergency team. Anaesth CaseforImplementingRRTsPresentation
in hospital outcomes: a cross-national study. Intensive Care. 1995;23:183-186. .htm. Accessed November 2, 2006.
Health Aff (Millwood). 1999;18:256-259. 11. Edson BS, Williams MC. 100,000 lives cam- 17. 100K lives campaign. Available at: www.ihi
5. Needleman J, Buerhaus P, Mattke S, Stewart paign and the application to children. J Spec .org/IHI/Programs/Campaign/Campaign
M, Zelevinsky K. Nurse staffing levels and Pediatr Nurs. 2006;11:138-142. .htm?TabId=1. Accessed November 2, 2006.
the quality of care in hospitals. N Engl J 12. Brindley PG, Markland DM, Mayers I, Kut-
Med. 2002;346:1715-1722. sogiannis DJ. Predictors of survival follow-
6. Gosfield A, Reinertsen J. The 100,000 lives ing in-hospital adult cardiopulmonary
campaign: crystallizing standards of care resuscitation. Can Med Assoc J.
for hospitals. Health Aff (Millwood). 2002;167:343-348.
2005;24:1560-1570. 13. Peberdy MA, Kaye W, Ornato J, et al. Car-
7. Institute for Healthcare Improvement. diopulmonary resuscitation of adults in the
Available at: www.ihi.org/ihi/programs hospital: a report of 14,720 cardiac arrests
/campaign. Accessed November 1, 2006. from the National Registry of Cardiopul-
8. Buist MD, Moore GE, Bernard SA, Waxman monary Resuscitation. Resuscitation.
BP, Anderson JN, Nguyen TV. Effects of a 2003;58:297-308.

http://ccn.aacnjournals.org CRITICALCARENURSE Vol 27, No. 1, FEBRUARY 2007 27


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CE Test Test ID C071: Rapid Response Team: Challenges, Solutions, Benef its
Learning objectives: 1. Identify 3 fundamental problems leading to failure to rescue 2. Describe the challenges in establishing a rapid response team
3. Discuss benefits of a rapid response team in terms of patient care

1. What group encouraged American hospitals to implement 7. Which communication technique was used at the Delnor
rapid response teams (RRTs)? Community Hospital in their implementation of RRTs?
a. The Institute for Healthcare Improvement a. BCLS
b. American Heart Association b. ACLS
c. American Hospital Association c. SBAR
d. Institute for Continuing Care d. SOAP

2. Why was the use of RRTs recommended? 8. What was the criteria for determining when the RRT should be
a. To improve patient outcome called known as?
b. To reduce hospital costs a. Initiation criteria
c. To prolong hospitalization b. Activation criteria
d. To reduce the risk of malpractice c. Problem criteria
d. Situational criteria
3. What is the goal of a RRT?
a. To provide rapid response to emergency room patients 9. What was the primary role of the RRT at Delnor Community
b. To provide rapid response to intensive care unit patients Hospital?
c. To prevent deaths outside of the intensive care unit a. Collaborate with the nurse at the patient’s bedside to determine if fur-
d. To prevent deaths in an emergency department ther interventions were needed
b. Review the chart for the previous 24 hours to determine what was
4. How does RRT foster collaboration? overlooked
a. Through chart review and recommendations c. Call the primary physician to report symptoms
b. Through assessment and immediate intervention d. Transfer the patient to the intensive care unit
c. Through medications and pharmacy consult
d. Through dietary and physical therapy consult 10. In the f irst 16 months after implementation of
Delnor Community Hospital’s RRT, the medical-surgical
5. How long before an unexpected critical event or actual unit code blues were reduced by what percentage?
cardiac arrest does a patient’s baseline begin to deteriorate? a. 56%
a. Mean of 30 minutes b. 68%
b. Mean of 2.5 hours c. 74%
c. Mean of 4.5 hours d. 86%
d. Mean of 6.5 hours
11. What was the challenge identif ied by intensive care unit nurses
6. What percentage of postoperative complications requiring trans- in acceptance of RRT roles?
fer to the intensive care unit can reportedly be reduced by RRTs? a. Communication with physicians
a. 30% b. Staffing cost
b. 42% c. Abandoning their own patients
c. 58% d. Daily collaboration with medical surgical nurses
d. 67%

Test answers: Mark only one box for your answer to each question. You may photocopy this form.
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Kc Kc Kc Kc Kc Kc Kc Kc Kc Kc Kc
Kd Kd Kd Kd Kd Kd Kd Kd Kd Kd Kd
Test ID: C071 Form expires: February 1, 2009 Contact hours: 1.5 Fee: $11 Passing score: 8 correct (73%) Category: A Test writer: Jane Baron, RN, CS, ACNP
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Rapid Response Team: Challenges, Solutions, Benefits
Kim Thomas, Mary VanOyen Force, Debbie Rasmussen, Dee Dodd and Susan Whildin
Crit Care Nurse 2007;27 20-27
Copyright © 2007 by the American Association of Critical-Care Nurses
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