Rapid Response Teams

Definitions

An RRT, or Rapid Response Team, is a designated group of healthcare clinicians who can be assembled quickly to deliver Advanced Care (ACLS or PALS) assessment and treatment expertise in response to the perceived or potential clinical deterioration of a patient.

RRTs may consist of any of the following staff positions with ACLS, PALS or advanced certification and training: (not intended as an exhaustive list)

  • Physician, anesthesiologist, intensivist, hospitalist, medical resident or telehealth provider
  • Critical care, emergency department or specialty RN (such as stroke, imaging or dialysis)
  • IV therapy, transport, float, medical-surgical or post-acute surgical unit RN
  • Clinical nurse specialist, nurse educator or house supervisor
  • Pharmacist, pharmacy resident, respiratory therapist or other staff

The varied expertise of the team is complemented by the focused expertise of the bedside nursing staff, patient and family. There is no set number of team members. Some hospitals will designate one or two team members while others have five or six. A rapid response team might be one individual per shift who can collaborate with the bedside nurse, patient and family when responding to a concern.

In every model, there are three key features of the team members:

  • They must be available to respond immediately when called
  • They must be onsite and accessible
  • They must have the advanced skills necessary to assess and respond (ACLS or PALS)

The RRT has several potential roles:

  • General rounding for staff support, enhanced surveillance and abnormal labs
  • Active screening for sepsis, suspicion of infection or changes in mental status
  • Transfer assessments, clinical outreach and continuous quality improvement
  • Investigation of unexplained pain, possible cardiac event or respiratory changes
  • Second victim support, nurse mentoring and professional development
  • Standardized safety net to reduce harm and improve clinical outcomes
  • Provide opportunities for collaboration and relationship building
  • Meeting the needs of patients, families, staff and providers

RRT Process Variation

  Initiation – who activates

Caregivers

Patient or Family

Other Initiators

  Clinicians – who responds

Unit Staff

Ancillary Staff

Virtual Providers

  Response Time – immediacy

3 to 5 minutes

5 to 10 minutes

10 to 15 minutes

  Location – on-site (ideally) versus e-ICU or on-call

On-site

Virtual

On-call

  Skills – advanced assessment (ACLS, PALS, TNCC, SCRN, etc.) 

Diagnostic

Therapeutic

Supportive

  Policy/Protocol – documentation of response process

Process

Training

Documentation

  Follow-up – with staff, patients and families

Clinical

Culture

Procedural

Seven distinct elements of a fully implemented Rapid Response Team process have been identified and are listed in the left column above. Variations in each element have been noted in the three columns progressing to the right. Many RRT processes incorporate more than one variation. For example, the same RRT process may be initiated by staff, as well as patients and families, or a hospital may have both on-site clinicians and virtual providers respond. Such variations are often required to meet the needs of patients, families and caregivers. These data are collected from journal articles, websites and regional survey responses. An eighth element has been proposed as the individual on whom the team is focused, as this is not always a patient.

Outcome Measure

Patient and family member-initiated Rapid Response Teams in the region as documented by the quarterly RRT Survey (or QBS 2.0)

Outcome Measure Numerator

Number of hospitals who have fully implemented patient and family member-initiated rapid response processes.

Outcome Measure Denominator

Total number of HIIN hospitals.

Process Measure

Staff-initiated Rapid Response Teams in the region as documented by the quarterly RRT Survey (or QBS 2.0)

Process Measure Numerator

Number of hospitals who have fully implemented staff-initiated rapid response processes.

Process Measure Denominator

Total number of HIIN hospitals.

Background

AHRQ: “Rapid response teams represent an intuitively simple concept: When a patient demonstrates signs of imminent clinical deterioration, a team of providers is summoned to the bedside to immediately assess and treat the patient with the goal of preventing intensive care unit transfer, cardiac arrest, or death. Such teams have become a widely used patient safety intervention due in large part to their inclusion in the Institute for Healthcare Improvement’s ‘100,000 Lives Campaign’ in 2005. However, the rapid response team concept has come to exemplify the tension between those arguing for swift implementation of conceptually attractive patient safety interventions supported by anecdotal evidence of benefit and those advocating a more rigorous, evidence-based–and inevitably slower–approach.”

IHI: “Failures in planning and communication, and failure to recognize when a patient’s condition is deteriorating, can lead to failure to rescue and become a key contributor to in-hospital mortality. If identified in a timely fashion, unnecessary deaths can often be prevented. The Rapid Response Team — known by some as the Medical Emergency Team — is a team of clinicians who bring critical care expertise to the bedside. Simply put, the purpose of the Rapid Response Team is to bring critical care expertise to the patient bedside (or wherever it’s needed).”

TJC: Goal 16A (2008): “Improve recognition and response to changes in a patient’s condition. The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patients condition appears to be worsening. Note: This requirement [incorporated] a one-year phase-in period [to identify] defined expectations for planning, development, testing, and milestones at three, six, and nine months in 2008, with the expectation of full implementation by Jan. 1, 2009.”

SCCM: “The literature on rapid response systems is burgeoning, and while some may debate the best approaches or measures of effectiveness, it is clear that a patient- and family-centered approach to rapid response is coming of age.

Patient and Family Member-Initiation

RRT’s are traditionally triggered by nursing staff, but some hospitals have allowed patients and their families to trigger an RRT. Other facilities have developed family activated response pathways for rapid patient assessment independently from RRTs. Family Activated Rapid Response Programs are known by many names. “Organizations empower staff, patients and/or families to request additional assistance when they have a concern about the patient’s condition [and] provide formal education for urgent response policies and practices for those who may request assistance and those who may respond to those requests.” This involves facilities engaging family caregivers in immediate alert pathways to enhance rescue efforts. Assessing and supporting this culture of Person and Family Engagement is the central focus of our RRT program.

 

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Washington State Hospital Association
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Seattle, WA 98104

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