Adding Critical Care Nurse Practitioners to Rapid Response Teams

Purpose:
Adding critical care nurse practitioners to rapid response teams prompts early diagnosis, intervention and management in acute situations.

Significance:
In 2004, the IHI initiated its 100,000 lives campaign targeting hospitals towards healthcare improvement. One intervention was that of deploying rapid response teams at the first sign of patient decline with research showing that patients exhibit signs of instability several hours prior to arrest.

Strategy and Implementation:
Since implementation of rapid response, Vanderbilt's program has been successful in decreasing code calls. However debriefings consistently identified the barrier of not having an immediate provider on the call. In January 2011, Vanderbilt's surgical and medical intensive care units (ICU) began a pilot project of deploying critical care nurse practitioners (NP) on the calls. The medical ICU sent NPs on calls both day and night while the surgical ICU sent NPs during the daytime only. In preparation, the critical care NPs were educated and trained in emergency response. Data was collected as to the NPs particular involvement on each call. The nurse practitioners were found to provide value to the rapid response team by decreasing time between symptom onset and treatment, providing consistent, early management, facilitating rapid transfer to the ICU when needed, promoting team communication and collaboration and performing emergent procedures when necessary.

Evaluation:
During the pilot, the NPs went to 244 calls, averaging 30 minutes per call. They facilitated 76 transfers to the ICU, generated 89 billing encounters and provided over 750 provider specific interventions. The most frequent diagnosis was hypoxemia, followed by tachyarrhythmia, hypotension and sepsis.

Implications for Practice:
The NPs were found to provide consistent, early management, facilitated rapid ICU transfers when needed, promoted team communication and provided staff and patient education. While collecting their data, process improvement initiatives and ideas for future expansion were identified.