Effect of a multi-faceted Rapid Response System re-design on repeat calling of the Rapid Response Team

Abstract

BackgroundRepeat Rapid Response Team (RRT) calls are associated with increased mortality risk to patients and pose a resource burden to organisations. Use of Non-Technical Skills (NTS) at calls has the potential to reduce potentially preventable repeat calling. NTS are usually improved through training, however this consumes time and financial resources. Modifications to the Rapid Response System (RRS) that promote use of NTS are worth exploring as a cost-effective alternative.MethodsA pre-post observational study of a RRS re-design on proportion of admissions each month subject to repeat RRT calling and number of calls per admission, with univariate and multivariable interrupted time series analyses comparing outcomes between study phases.ResultsThe proportion of admissions with repeat calls each month increased across both phases of the study period, but the increase was lower in the post re-design phase (change in adjusted regression slope -0.12 (standard error 0.07) post versus pre re-design). The multivariable model showed an estimated 6.0% reduction (P=0.19) in the proportion of admissions having repeat calls at the end of the study versus that predicted had the re-design not occurred.For the number of calls per the multivariable model predicted a reduction of 0.07 calls per admission at the end of the post re-design phase (95% confidence interval -0.23 – 0.08, P=0.35), equating to one fewer repeat call per 14 patients having RRT calls.ConclusionThis study showed no observed statistically significant effect on rates of repeat calling or numbers of repeat calls per admission from the implementation of a RRS re-design. However, the results demonstrate, at an organisational level, the feasibility of a low-cost initiative to improve NTS use by the RRS.

Rapid Response System Restructure

“…Recent studies have suggested that proactive resuscitation models may prevent adverse events, disseminate expertise, provide support to novice staff, and reveal quality improvement opportunities. 2 Initiatives such as capitation, pay-for-performance, value-based purchasing, and quality measure compliance affect resource allocation; therefore, innovative solutions are needed to address complexity of care, cost containment, and staffing constraints. 3 This article describes the staged restructure of a consultative ICU rapid response nurse (RRN) to a dedicated 24/7 RRN model of care in a quaternary academic medical center in the southern United States.…”