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Wednesday, February 16, 2011

Rapid Response Teams

Studies show that most people do not have spontaneous heart attacks or strokes or go into sepsis without first showing early signs that something is going on. Therefore, the vigilant nurse or respiratory therapist who picks up on these signs can save a life and prevent a prolonged hospital stay.

In this way, we might prevent a catastrophe we might not even ever get credit for. And that, in my opinion, is the greatest job of working in the medical profession. We like to call it being proactive.

Thus, being proactive is the purpose of Rapid Response Teams. It's about educating nurses and respiratory therapists on what signs and symptoms are worrisome, and when to call the doctor. To learn when to call the doctor, click here.

According to "Respiratory Therapists Play Unique Role on Rapid Response Teams," by Steve Babyak (RRT) in the AARC Times (June 2007), studies performed show the following:
  • 66-84% of patients exhibit abnormal signs and symptoms within 6 hours of an arrest, including altered mental status, chest pain, fluctuations in heart rate, respiratory rate and blood pressure, tachypnea (58%), tachycardia (54%), hypotension (46%) and decreased urine output (29%)
  • Elevated respiratory rate is an indicator of muscle weakness and fatigue. 54% of patients requiring CPR had at least one documented increase in respiratory rate above 27 breaths per minute within 72 hours of arrest.
  • 65% drop in cardiac arrests and 56% decrease in deaths from cardiac arrest following the placement of a medical emergency team (rapid response team)
Babyak notes rapid response teams were first "pioneered" in Australia in 1990 and were found to be so successful (see statistics above) that they quickly found their way to hospitals around the world.
Rapid Response Teams generally consist of one critical care nurse, the nursing supervisor, respiratory therapist, and the patient's nurse. In some hospitals it would also include a physician, yet Shoreline does not have an inhouse physician. So this makes it even more important for us, because it allows us to use our skills to save a patient using the guidelines and policies created for the team.

For instance, we are allowed to do EKGs, ABGS, give certain medications, and even order X-Ray and labs even before the doctor is notified, all in an attempt to get the patient fixed and to prevent the patient from getting worse.

We are also allowed to place patients on oxygen, give beta-agonists, morphine and initiate BiPAP if needed. Actually, we aren't allowed to initiate BiPAP, although some hospitals allow for this.

Another advantage of RRTs is that they decrease the number of patients transferred to critical care, and decrease length of stay. I imagine they also increase patient outcomes and satisfactions.

As a nurse is doing rounds, or the RT is doing his rounds, we assess the patient. If we notice mental changes, vital signs that are critical, low oxygen saturations, altered breathing patterns or cardiac rhythms, changes in blood pressure (too high or too low), or simply if we think something is wrong and don't know what, then we can trigger the team.

Thus, as Babyak writes, rapid response teams are a great "opportunity for respiratory therapists to bring their experience and expertise to a progressive format that is rapidly improving the safety and well-being of the hospitalized patient."

Further reading:
  1. Do rapid response teams work?
  2. How to know when to call a doctor
  3. AARCs Rapid Response Team Page

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