Rapid Response Teams, Saving Lives through
Collaboration…
Successes and Lessons Learned
by
Kathleen Carey, RN, CNS-BC, CCRN
Jodi 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 informatics
From 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 Journey
Saving 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 Relationship
Per 1000 Patient Days
6.00
5.00
4.00
3.00
Jul-Dec '05
2.00
1.00
0.00
2005
2006
2007
Codes
2008
2009
RR's
2010
Utilization of Rapid Response Team
350
300
250
200
Jan-Oct '10
150
Jul-Dec '05
100
50
0
2005
2006
# of RR
2007
2008
# Stay in Room
2009
2010
Unplanned Transfers With Rapid Response
2010
60
50
40
30
20
10
0
Jan
Feb
Mar
Total Transfers
Apr
May
Jun
Total RR Calls
Jul
Aug
Sep
Oct
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
 Staffing
 Resistance to
 Skilled know-how
change
 Physicians’
perceptions
 Delay in calling
 Clinical grasp
 Clinical inquiry
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