Abstract 223: Rapid Response Teams at Top-performing Hospitals for In-hospital Cardiac Arrest: A Qualitative Study

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Background: Prior studies have shown that hospitals with exceptional survival for in-hospital cardiac arrest (IHCA) also excel at preventing IHCA—a key function of rapid response team (RRT). However, little is known about how RRTs differ across sites. We used qualitative methods to evaluate organizational and contextual factors of RRTs that may be linked to hospital performance on IHCA survival. Methods: We selected 9 academically and geographically diverse hospitals in the AHA Get With The Guidelines Resuscitation registry based on risk standardized IHCA survival during 2012-2014 (top quartile: 5 hospitals; middle quartiles: 1 hospital; bottom quartile: 3 hospitals). During site visits, we conducted semi-structured interviews with key stakeholders regarding resuscitation care at their site. We conducted a directed content analysis focused on RRT roles and activities related to preventing IHCA. Results: A total of 158 interviews were conducted that included physicians (17.1%), nurses (45.6%), other clinical (17.1%), and administrative staff (20.3%). Differences in RRTs at top and bottom performing sites were noted in the following domains: team design and composition, engagement of RRT in surveillance of at-risk patients, empowerment of bedside nurses to activate RRT, and collaboration of RRT members with bedside nurses during and after a rapid response. Differences within each domain and representative quotes are included in the Table. Top performing hospitals tended to have RRTs staffed with members without other clinical responsibilities, often served as a resource for bedside nurses in preventing patient decline, and collaborated with them during and after a rapid response. Bedside nurses were empowered to activate RRTs based on their judgement and experience. In contrast, RRTs at bottom performing hospitals were staffed with members with competing clinical responsibilities, and were generally less engaged with bedside nurses. Moreover, nurses were concerned about potential consequences (e.g. fear of reprisal from physicians) in calling a rapid response. Conclusions: The design and implementation of RRTs differ markedly between top and bottom performing hospitals with regard to IHCA survival. Our findings provide unique insights into RRTs at hospitals with better IHCA outcomes.