The Tipping Point: Factors that Influence Nursing Decisions about Calling a Rapid Response Team

Purpose:
The goal of the study was to explore the factors that influence nurses' decisions about when to call a physician versus when to call the RRT.

Background/Significance:
In 2007, Inova Mount Vernon Hospital instituted Rapid Response Teams (RRT) as part of our hospital's participation in the Institute for Healthcare Improvement's call for hospitals to “Save 100,000 Lives”. In a recent survey at our hospital, nurses reported positive views about the RRT. Yet 51% of them also stated that they would call the house officer or physician before they called the RRT for their patients who met RRT criteria.

Methods:
We chose a qualitative focus group methodology to explore the topic. 10 nurses from medical, surgical, and rehabilitation units, and from day and night shifts, and who had previously called an RRT, participated. We started with open-ended questions. Semi-structured discussions allowed us to elicit information and explore nurses' critical thinking about how they make those decisions. Discussion continued until no new ideas or information was forthcoming. The focus group was taped and transcribed. Both researchers reviewed the transcript for accuracy, independently coded the data and extracted primary themes. We then compared our analyses to reach consensus on the themes.

Results:
Multiple factors go into the nurses' decision to call. These include the opinions of their colleagues obtained via consultation, whether they had exhausted their ability to independently manage the situation, and who the physicians involved are. Calling an RRT without first attempting to manage the patient's situation is almost seen as inappropriate and an abdication of nursing autonomy but a related finding of note is that the average reported time lapse from time of initial concern to RRT call was 30 minutes to 1 hour. The tipping point occurs when any or all of the above factors combine with the patient's clinical picture to become heavy enough to “tip” the nurse into calling an RRT.

Conclusions and Implications for Practice:
The RRT was intended to prevent "failure to rescue" by mandating nurses call a medical team for patients with changes in clinical status. In practice, few nurses automatically call. Understanding how nurses make the decision to call an RRT can impact education and procedures around this resource.