Transforming the Rapid Response Process

Purpose:
Missed RRT opportunites and generating effective call volumes is challenging. A proactive,collaborative nurse driven Rapid Response system improves outcomes. Enhancing visibility of the RRT RN and using an innovative approach to identifying vulnerable patients are strategies that yield results.

Significance:
RRT teams aim to eliminate failure to rescue. Missed opportunites are costly to patients and hospitals. Measuring effectiveness of RRT teams is difficult. This strategy improves call volumes, reduces emergent events and improves lives saved. Also offered are measurements of effectiveness.

Strategy and Implementation:
A process employing active surveillance of the electronic medical record by a dedicated Rapid Response RN each shift for signs of clinical triggers was implemented. This was combined with active patient rounding on all transfers out of ICU along with all patients post RRT call for 2 consecutive shifts. Sepsis screening also supplemented cuurent clinical triggers. Staff education in staff meetings, email notices and posted flyers alerted to the change in process. RRT RN meetings were held to explain the project, emphasis, goals and methods. Forms were used to track rounds each shift and data was gathered to assess results. RRT RN team meetings continued and respiratory therapy was included. Team building was ongoing between RRT members and ward staff as well as educators and supervisors. Data is collected and analyzed. Results are fed back to the team for encouragement and analysis of outcomes to look for additional ways to improve. Results and innovation is shared with others.

Evaluation:
Measurements of effectiveness include code blue rates outside ICU,# emergent events outside ICU including respiratory arrests, call volume per thousand discharges, % transfers to ICU post call, #'s unplanned ICU transfers without RRT. Our process improved outcomes in all of these measures.

Implications for Practice:
A process generating increased usage further reduces adverse events and promotes beneficial patient and facility outcomes. A model that promotes primary RN activation as well as a proactive, involved RRT RN with objective goals and measures of effectiveness may become new evidence based practice.