304: NOVEL CRITICAL CARE OUTREACH TEAM MODEL IMPROVING RAPID RESPONSE OUTCOMES

Abstract

Introduction: The process and outcomes of a novel Critical Care Outreach Team (CCOT) staffed with dedicated critical-care advanced practice providers (APPs) collaborating virtually with an intensivist responding to rapid response team (RRT) activations is described. Methods: Upon RRT activation, the CCOT APP responds to the bedside to assess the patient and acute clinical situation while the CCOT intensivist reviews the electronic medical record for situational awareness of the patient’s hospital course. The CCOT APP and Intensivist in conjunction with the primary team develop a clinical care plan to manage the acute event. The CCOT APP remains with the patient until stabilization or escalation to the intensive care unit (ICU). The CCOT intensivist helps facilitate communication with primary and ICU teams, ensuring timely ICU transfers. CCOT interventions include medications, diagnostics, facilitating consults, transport, escalation of care, transitioning to comfort care, timely follow-up, and multidisciplinary communication. Results: CCOT evaluated 1,862 patients from July 2021 to June 2022 in a large, academic adult hospital. The average time spent on activations was 52 minutes with an average of seven interventions/patient. The ICU transfer rate decreased (37.0% from 46.6%) with no change in mortality (9.0% to 9.8%). Stepdown transfer increased from 3.7% to 9.3%. RRT documentation increased to 100% from 74%. Conclusions: A CCOT with dedicated APPs collaborating with a virtual intensivist can stabilize acutely deteriorating patients by remaining at the bedside, providing advanced interventions, improving communication with bedside providers, and decreasing the need for ICU transfers without increasing mortality. Improved documentation provided improved communication and billing for the institution.