Rapid Response TeamRRT

What is RRTA Team designed for early intervention for potentially unstable patientsA Proactive approach to patient care

Who makes up the RRTVaries Widely• Nurses• Respiratory Therapists• Physicians (Attendings, Fellows & Residents)

Research FindingsMajority of patients who arrest in the hospital have signs of deterioration for 6-8 hoursSaves LivesReduces LOSCalls for RRT’s doubles after the 1st year implementation30 % decrease in cardiopulmonary arrests in one documented study.Approximately 40 % of patients survive to discharge following RRT activation

Research Findings cont’dExpedites DNR decisions in appropriate casesOften only simple interventions needed

One of 8-1600’s RRT calls found a patient was on 3x’s glucophage, admission was avoided with medication adjustment

Facilitates staff education

Suggested Criteria for Initiating RRT

Evidence-based literature findings:• Initial call should be made to

appropriate covering physician or team prior to initiating RRT call •Staff member worried about the

patient•Inadequate or untimely response

from covering team

Criteria cont’dAcute Change in:

Heart Rate <40 or > 130SBP < 90 mm HgRR <8 or >30O2Sat <90Mental Status (LOC)UO < 50 ml/hr

Top 5 Interventions for RRT Calls

Oxygen therapyNon-invasive positive pressure ventilation by mask or ventilatorNebulizer treatmentsIV fluid bolus requiredLasix administered

Potential Economic BenefitConservatively ICU care costs $2,000-$3,000/dayIf 10% of admissions avoided and 10% of those patients admitted to ICU have shortened LOS’ we would save 5,500 ICU days. Results in $11,000,000 savingsOpens up additional ICU beds for patients requiring admission. Facilitates more timely admissions from the Floor, ED, PACU and outside transfers

MICU RRT ExperienceMICU Responders

Charge NurseResident (Fellow/Attending)

Started July 2003 on 2 units, gradually increased to 6 units (medical)From July 2003-May 2004: 24 calls, 15 admissions (42.4% saved ICU admissions)57.6% of patients admitted after a RRT response had 1.4 days less ICU LOS

MICU Experience cont’dTop 3 Primary events for calls made:

Respiratory DistressHypotensionChange in LOC

Time Investment:10-60 minutes per call

Rapid Response Team

00.5

11.5

22.5

33.5

44.5

Dates

Rat

e CallsAdmissions

1

1

1

1 Staff Education2 RRT Model modified/Education

2

Barriers Late Calls…near arrestUnits initially hesitant to call for helpConcern about floor physician/ICU physician conflictFloor nurses concerned about “going over someone’s head”Limitation of resources…using stressed resourcesDocumentation of event

No documentation from requesting unitsInconsistent documentation from responders

PLANModify RRT Model

Responders are now ICU Charge Nurse and Respiratory Therapy Supervisor. Attending/Resident/Fellow/NP will respond when appropriate and requested by the RRT

EducateRRT Presentation to Leadership and Staff

Collect DataOngoing collectionAnalyze and track trends

Evaluate and ReportEffectiveness of RRTBarriers Patient outcomes