rapid response teams, saving lives through collaboration… successes and lessons learned by...
TRANSCRIPT
Rapid Response Teams, Saving Lives through Collaboration…
Successes and Lessons Learned
by
Kathleen Carey, RN, CNS-BC, CCRNJodi Hamel, RN, CCRN
Rapid Response Teams Institute for Healthcare Improvement (IHI) in December 2004 launched the
“One Million Lives” campaign recommending Rapid Response Teams (RRT’s) be placed in hospitals
More than 3000 hospitals participated in the campaign
2005 RWJ funded “learning networks” for implementation
IHI unveiled “Five Million Lives” campaign expansion in 2006
2007 RRT’s were in more than1500 US Hospitals
US News and World Report and the Wall Street Journal reported the potential benefit of RRT
2008 Joint Commission added NPSG 16A
Institute of Medicine Core Competencies
Provide patient-centered care
Work in interdisciplinary teams
Employ evidence-based practice
Apply quality improvement
Utilize informaticsFrom Health Professions Education: A Bridge to Quality.
Institute of Medicine, 2003
Purpose and Goals of RRTs
Rapid response teams are expert clinicians who respond and provide interventional care to patients experiencing acute changes in their conditions. The goals of the team are to recognize early signs of patient deterioration and to prevent avoidable code events.
IHI recommends a goal of 25 RRT calls per 1000 pt discharges or 10 calls per every 100 occupied beds
CVPH Rapid Response JourneySaving Lives through Collaboration
CVPH is 341 bed non-profit community hospital
Rapid Response Team (RRT) began in July 2005
Nurse Consultation Model, Lewin's Change and Watson's Caring Theory; theoretical framework
Systems analysis and improvement
RN empowerment
Physician and staff education
Response team consists of an ICU RN, RT, PCC
Code/Rapid Response RelationshipPer 1000 Patient Days
0.00
1.00
2.00
3.00
4.00
5.00
6.00
2005 2006 2007 2008 2009 2010
Codes RR's
Jul-Dec '05
Utilization of Rapid Response Team
0
50
100
150
200
250
300
350
2005 2006 2007 2008 2009 2010
# of RR # Stay in Room
Jan-Oct '10
Jul-Dec '05
Unplanned Transfers With Rapid Response2010
0
10
20
30
40
50
60
Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Total Transfers Total RR Calls Total Transfers with RR
Promoting Nursing's Future The Nursing Consultation Model
Reduction of inpatient codes (exclude ICU)
Education through nursing consultation
“Save of the Month”
Implementation of family RR calls
Collaboration of healthcare team
Growth of consultation models
Promoting Nursing's Future A Bridge to Clinical Wisdom
RR calls decrease transfers to HLOC Yearly education Admission brochure (Soarian) Annual Executive Board presentation Call early; call often Story telling at Hospital Practice Council Dynamic rapid response practice team
Lessons Learned
Staff perceptions Resistance to
change Physicians’
perceptions Delay in calling Clinical grasp Clinical inquiry
Staffing Skilled know-how
of coaching Newly hired
staff/physicians Family RRT calls Unplanned
transfers
Conclusions RRT widely accepted 8-12% reduction in codes outside ICU 13% increase in RR calls 74% of calls; patients remain in room 32/month unplanned transfers 75% of transfers are without RR call Senior leadership support Nursing consultation model growth Family initiated calls slow progress
Key Elements Clinical coaching with each call 3 C’s computer, chart, caller Embrace clinical inquiry “I need another set of hands” Invite senior leadership to “Save of the
Month” recognition Family/patient education on admission Hardwire RRT process with ongoing
education Perception awareness
Rapid Response Team Still Not Cutting It?
RRT inconclusive; vigorous debate
Chan et al, 2010