Rapid Response Team Benefits Nurses
Providing excellent care to patients and families by the best staff in the safest environment also means that no nurse will feel left alone in his or her practice. To achieve this, the nursing service regularly participates in piloting programs such as the Rapid Response Team. In this program, nurses collaborate with physicians, respiratory therapists and others to bring patients excellent care while providing support and consultation to nurses during one of the most critical and stressful times—when a patient demonstrates signs of failing.
The Rapid Response Team (RRT) pilot at BWH is proving a positive experience for patients and nurses. The purpose of the RRT is to bring resources to the patient at the first signs of deterioration in order to prevent an acute emergency or cardiac arrest. In addition, the team also aims to catch patients who are failing early enough to prevent ICU transfer. If transfer is necessary, the RRT attempts to send the patient to the ICU earlier in order to use evidence-based therapies proven to improve outcomes.
The RRT consists of a nurse with critical care experience, a respiratory therapist and an intern or resident. Direct care nurses on Tower 14, where the pilot is in progress, are vigilant to identify the early warning signs exhibited by patients before a full-blown emergency occurs, such as cardiac arrest. If a patient demonstrates any of the signs outlined by the RRT, the nurse calls the RRT. Responding immediately, the team works with the direct care nurse to prevent a critical event before it happens, often saving the patient’s life.
Patients on Tower 14 are incredibly acute, said Cindy Lemay, RN, nurse manager of 14CD. “The patients can be challenging, and we’re finding the Rapid Response Team really supports the nurses by providing immediate backup,” she said. “But it also validates them. Our nurses have grown, and they are better able to manage their patients because of what they learn when they are part of the response.”
The nurse who calls the RRT is an important part of the response, explaining the situation and patient’s background to the RRT, and learning from the team’s assessment, recommendations and interventions.
Matthew Quin, RN, a critical care nurse on the RRT, agrees. “When I respond to a call, I run through my assessment of the patient with the nurse, and he or she sees what I’m checking for and why. They can then pull that into their practice.”
The pilot began on Tower 14 in December. With three months left in the pilot, Jeffrey Rothschild, MD, who received a grant to conduct the pilot, shared early findings at Quality Rounds in March. As of the week of March 5, the RRT had been called 71 times—almost once per day since the pilot began. “We did not expect that many calls,” Rothschild said. “We expected maybe half that number.”
Of those calls, about a third of the patients were transferred to intensive care, while two thirds were stabilized and remained on the floor. Five of six patients survived cardiac arrest.
As part of the pilot, Rothschild and his team are surveying nurses who call the RRT and RRT members who respond. According to the surveys, most nurses believe the RRT benefited the patient, and they said they would call the team again. The response team members reported most calls they received as appropriate and warranted their response.
Rothschild next plans to measure the utilization and impact of the rapid response system. He will work to refine early warning criteria, assess the effect of the RRT on resident education and develop a careful plan for possibly employing the RRT in other patient care areas.