Designing a Critical Care Nurse–Led Rapid Response Team Using Only Available Resources: 6 Years Later

Abstract

Rapid response teams have been introduced to intervene in the care of patients whose condition deteriorates unexpectedly by bringing clinical experts quickly to the patient’s bedside. Evidence supporting the need to overcome failure to deliver optimal care in hospitals is robust; whether rapid response teams demonstrate benefit by improving patient safety and reducing the occurrence of adverse events remains controversial. Despite inconsistent evidence regarding the effectiveness of rapid response teams, concerns regarding care and costly consequences of unaddressed deterioration in patients’ condition have prompted many hospitals to implement rapid response teams as a patient safety strategy. A cost-neutral structure for a rapid response team led by a nurse from the intensive care unit was implemented with the goal of reducing cardiopulmonary arrests occurring outside the intensive care unit. The results of 6 years’ experience indicate that a sustainable and effective rapid response team response can be put into practice without increasing costs or adding positions and can decrease the percentage of cardiopulmonary arrests occurring outside the intensive care unit. (Critical Care Nurse. 2014; 34[3]:41–56)

Rapid response teams in adult hospitals: time for another look?

“…65 A 6-year study of an ICU nurse-led RRT reported sustained reductions in cardiopulmonary arrests. 66…”

“…In contrast, a retrospective observational study comparing ICU‐led and resident physician‐led RRT found no difference in cardiac arrests, ICU admissions, or hospital mortality . A 6‐year study of an ICU nurse‐led RRT reported sustained reductions in cardiopulmonary arrests …”

Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues

“…There is currently little evidence to guide recommendations regarding RT staffing composition, except that responses to deterioration are more likely to be effective when a clinician with critical care skills is leading the RT event (McNeill & Bryden, ). Whether RT should be medical specialist‐led (Al‐Qahtani et al., ), primary care team‐led (Howell et al., ; Moldenhauer, Sabel, Chu, & Mehler, ) or nurse specialist‐led (Mitchell, Schatz, & Francis, ; Pirret, Takerei, & Kazula, ) is unclear. Other variations in RT composition occur between organisations according to “individualised” predetermined clinical parameters and recommended responses (Psirides, Hill, & Hurford, ), which again are adapted locally to align with relevant policies protocols and resources (Australian Commission on Safety and Quality in Healthcare ).…”

Rapid Response Teams Decreasing Intubation and Code Blue Rates Outside the Intensive Care Unit

“…Furthermore, a retrospective chart review indicated that before implementation of the RRT, the percentage of cardiopulmonary arrests was 83% or 1.84 per 1000 discharges and mortality was 1.42 per 1000 discharges whereas after RRT implementation, cardiopulmonary arrests decreased to 12.7% or 1.7 per 1000 discharges and hospital mortality decreased to 1.25 per 1000 discharges. 3 Certainly the success of the RRT relies on staff awareness and willingness to activate it. Our initial diffi culties with RRT activation are refl ected in the review of the literature.…”

“…1 Most in-hospital arrest states are caused by respiratory compromise and hypotension. [2][3][4] RRTs were based on the finding that caregivers outside of intensive care units (ICUs) often were unable to recognize these and other early signs and symptoms of patients' deteriorating condition or waited too long to call for assistance to prevent a cardiac arrest, which can occur up to 6 hours before a code blue situation. 1,[4][5][6] At the first sign of deterioration, RRT activation brings critical interventions to the bedside, including a team of multidisciplinary critical care providers and resources 4,7 (Table 1).…”