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Thursday, April 26, 2012

Do Rapid Response Teams work?

Hypothesis:  I personally believe that the more people caring for a patient, and the more people assessing the patient, the better off the patient will be.  It is for this reason I think Rapid Response Teams are a good method of preventing patients from going into respiratory and/or cardiopulmonary arrest, and thereby improving patient outcomes by preventing the need to transport patients to the Critical Care Unit (CCU).

Question:  Do Rapid Response Teams really work?  This was a question recently taken up by, "Are Rapid Response Teams the Answer?"  The article, written by Michael V. Frey, RRT/ NPS, creates several good arguments that the answer to the question may be no.

What is a Rapid Response Team (RRT)?  It's a team of experts who respond to the patients bedside when the patient doesn't look quite right to the attending nurse or physician.  The team consists of CCU nurse, Nursing Supervisor, Respiratory Therapist, Physician (if one is available) and the patient's nurse.  The goal is to be proactive and do what is necessary to prevent the patient from getting worse.  

Why were RRTs believed to be a good thing?  According to Frey

1.  Most floor nurses lack critical care experience

2.  Some nurses were hesitant to do proactive therapies without a physician's  order.  This is important because sometimes it takes a while for the physician to call back, and the patient needs something done right now.  For our small town hospital, I think this was the key to forming an RRT.  There were many times a nurse wouldn't treat the patient that needed immediate attention just because she didn't want to do something without an order.  RRTs eliminated this, and the end result has prevented such patients from needlessly ending up in the CCU.  This I would consider the most valid reason for an RRT.  

The following studies seem to show RRTs work, as mentioned by Frey:
  • 50% reduction in the occurrence of cardiac arrest outside the ICU
  • 17% decrease in the incidence of cardiopulmonary arrests (6.5 versus 5.4 per 1,000 admissions)4;
  • Severe postoperative adverse events (ie, respiratory failure, stroke, severe sepsis, acute renal failure) reduced by 58%5;
  • Emergency ICU admissions reduced by 44%5;
  • Postoperative deaths reduced by 37%, and mean duration of hospital stay decreased from 23.8 to 19.8 days in surgical patients5; and
  • There has been a decrease in the number of unnecessary transfers to a higher level of care by a mean of 30%.6
The argument against RRTs:  (According to Frey)

1.  RRTs are a band aid solution to a bigger problem of nurses not understanding the needs of their patients.

2.  Some patients are on the medical/ surgical floor, or step down unit, only because there are no beds available in the CCU.  It's these patients who are at greatest risk for deterioration.  

3.  Due to cost cutting, some patients are moved our of CCUs and to step down units.  These patients are also at high risk for deterioration.

Conclusion;  I think the general conclusion is that RRTs work.  My experience with them is they work, and I noted one very good reason above:  At a small hospital, we don't have physician coverage 24 hours a day, and therefore RRTs sort of fill the gap between observation of a deteriorating patient and communication with the physician.  

Surely, however, there are methods that could be improved.  For example, if the CCU nurse already has several critical patients, it's difficult for that person to be pulled away from his already critical patients to care for a patient of another nurse.  However, all in all, I think the teams are working, and the statistics show they are working.  

What do you think?


okacookie said...

I work at a large hospital and we use a Rapid Assessment Team (RAT), and they work very well but what I have seen is that nurses, RTs, techs, etc. sometimes are reluctant to call a RAT because they don't think their patient is sick. When that happens the patient gets worse until someone finally does something.

The hospital just needs to stay on top of training people what to look for.

okacookie said...

We use a Rapid Assessment Team (RAT) at our hospital, and it seems to help when it is used correctly. I have also been told that soon Medicare will stop paying for codes that happen outside of the ICU. The biggest problem that I have seen is that staff are sometimes reluctant to call a RAT because they don't feel like the patient is that sick. The hospital needs to stay on top of training and making sure all of the staff knows what to look for.