Beyond Rapid Response: Preventing failure to rescue in a large tertiary hospital in New York City

Purpose:
To describe the Rapid Response System at Maimonides Medical Center, a 705 bed tertiary hospital in Brooklyn, NY. The Rapid Response System was designed to be proactive and to enhace a culture of safety.

Significance:
Rapid Response Teams were designed to rescue patients from potential life threatening events. At Maimonides, The RRT consists of a Hospitalist, Respiratory Therpist and a designated RN which allows for a broader range of early patient detection and unique educational opportunities for staff.

Strategy and Implementation:
In 2007, The Rapid Response Team was designed at Maimonides Medical Center with a designated critical care nurse, without patient assigment, available to perform patient surveillance through organized rounding, frequent vital sign checks, monitoring of non-ICU patients on vasoactive drips, assessment of all non-ICU patients with artificial airways and staff formal and informal education. This innovative design allows the nurse to be a consistant and active clinical leader providing advocacy and mentorship to other nurses and physicians. The RRT nurse attends all non-ICU codes and serves as an educator for all physician members of the code team and nursing staff to ensure ACLS protocols are implemented.

Evaluation:
Outcomes since implementation include a 14.2% decrease in inpatient mortality rate,30.4% decrease in rate of codes outside ICUs per 1000 discharges. An increase in adherence to Standards of Nursing Care, Improvement in RN and MD satisfaction in all indicators of the RRT Staff Satisfaction Survey.

Implications for Practice:
Creative and innovative design of rapid response teams can support and enhance a culture of safety in a proactive manner, preventing failure to rescue. Having a dedicated critical care nurse on the code team has led to better code compliance and care of the patient post code.