Hospital Rapid Response Team Research Articles

Implementing Best Practices for Decreasing Nurse Hesitancy to Call the Rapid Response Team: An Evidence-Based Quality Improvement Initiative.

Nurses, regardless of experience, sometimes wait for the Modified Early Warning Score to indicate physiological decline before initiating the hospital's Rapid Response Team (RRT). The goal of this quality improvement initiative was to reduce nurse hesitancy to call the RRT, as indicated by the monthly number of proactive calls before the Modified Early Warning Score increased and triggered an automated page. Education, planned handoff communication, debriefing, and good catch emails were the educational strategies used in the implementation of the quality improvement initiatives, encouraging RRT calls sooner. Increasing RRT knowledge and communication is an evidence-based practice strategy to reduce nurse reluctance to call the RRT. After implementation, monthly proactive RRT calls increased (χ2 [1, n = 1,964] = 14.6085, p = .000159). Bedside interventions, unscheduled transfers, and Acute Physiologic and Chronic Health Evaluation scores did not differ. Education, structured handoff communication, and acknowledging good catches reduced nurses' reluctance to call the RRT proactively. [J Contin Educ Nurs. 2023;54(6):281-288.].

Family support role in hospital rapid response teams: a scoping review

The objective of this review was to identify and understand the primary research investigating the family support role in hospital rapid response teams. Individual studies have described the benefits of providing emotional and psychosocial support to family members of a person receiving emergency medical care from a rapid response team in a hospital setting. To the authors' knowledge, there are no studies that have identified and described these studies together. All empirical qualitative and quantitative papers investigating a family support role delivered in a rapid response team in a hospital setting were included. This review followed a published a priori protocol. The databases searched were MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane Library, and OpenGrey. The search strategy was not limited by publication date or by language. The title and abstract of all citations were reviewed by two authors independently to assess against the inclusion criteria. The full text of the studies meeting the inclusion criteria were retrieved and reviewed by two authors independently. Data from eligible studies were extracted by two authors separately using a predetermined data extraction form and summarized in tabular and narrative format. After a full-text review of 110 studies, six studies met all inclusion criteria. The studies were set in four countries. All rapid response teams were set in hospital locations. Charted data demonstrated that the family support role had been investigated predominantly by qualitative study designs from the perspective of staff delivering the support. One study reported health outcomes of family members who received family support. In all studies, the family support role was part of a resuscitation rapid response team. Family support was provided at all stages of the resuscitation procedure. The family support role was not consistently defined, with the activities of the family support person reported differently between studies. Twenty-five varying support activities were described, such as attending to the family members'comfort needs, explaining the process of resuscitation, and providing guidance to the family member. In all studies, the family support role was available to support the family witnessing the resuscitation. The family support role was delivered by professionals from varying disciplines, including social workers, nurses, health care workers, and health care chaplains. Family support roles are varied and are carried out by health professionals of diverse backgrounds, highlighting the importance of considering the support and training needs of the person performing the role. Future research using evaluation methods is recommended to deepen the understanding about the family support role in hospital-based rapid response teams.

Usability Evaluation of the Electronic Medical Record of the Rapid Response Team: a Case Study

Aim: This study was conducted to determine the usability of the rapid response team (RRT) electronic medical records (EMRs) system at an Abu-Ali-Sina organ transplant hospital, Shiraz, Iran. Method: This cross-sectional study was carried out in partnership with 25 direct members of RRT includes nurses and anesthesia technicians who were on the shift during the data collection for two months. To evaluate, the Questionnaire for User Interaction Satisfaction (QUIS) version 7 was used. Data were analyzed by SPSS version 19. Results: A total of 20 out of 25 questionnaires were obtained. Seven (25.0 %) of 27 sections were higher than seven, and all areas were higher than five. The highest rankings were for 1) reading characters on the computer screen 2) highlighting on the screen simplify task 3) overall reactions: wonderful and learning to operate the system. Conclusion: This study demonstrates the usability of the hospital RRT for the EMRs system and over the moderate. However, the flexibility and capability of the rapid response for EMRs tool require to be improved.

The family support role in hospital rapid response teams: a scoping review protocol.

The objective of this review is to identify and understand how a family support role has been delivered in rapid response teams in hospital settings. A family support role in a hospital rapid response team is a designated position that is responsible for supporting the family members of people being medically attended to during a hospital rapid response. Support may include the provision of guidance to the family regarding a hospital procedure, support whilst witnessing the rapid response, or assisting the family to process their emotional response. This review will assist in identifying the ways in which the family support role is delivered in rapid response teams within a hospital environment. Family support must be delivered by a person who has a designated family support role within a rapid response team in a hospital setting. Studies will not be limited to geographical location, gender, or culture. Studies are not limited to year of publication or methodological design. Databases will include MEDLINE (Ovid), Embase (Ovid), CINAHL, and Cochrane. Gray literature will be searched with predetermined search criteria. Two independent authors will be used to screen articles and perform data extraction on a predetermined data extraction form. A narrative Summary of Findings is planned, alongside a presentation of the data in diagrammatic or tabular form.

Patients’ experiences of acute deterioration: A scoping review

BackgroundPatient experience is recognised as a means of assessing healthcare delivery with organisations in many countries now gathering patient experience or satisfaction data. It is well documented that the benefits of improving a patients' experience include increased satisfaction, reduced length of stay, improved patient outcomes and reduction of costs. The experience of acute clinical deterioration is unique, extensive and complex as well as being a difficult experience for all involved. However, little is known about this experience from the patient's perspective. AimTo explore what is known about the experiences of acute deterioration from the perspective of the patient. DesignA scoping review of international, peer-reviewed research studies and grey literature published between the years of 2000 and 2018. This review was guided by the three-step search strategy recommended by the Joanna Briggs Institute (JBI). Data sourcesA range of databases were searched, including CINAHL, Medline, Health Source, Joanna Briggs Institute, PsycINFO, Embase via Ovid, Cochrane library, Ovid Emcare, Scopus as well as grey literature, reference lists and the search engine Google Scholar. Review methodsJoanna Briggs Institute (JBI) scoping review framework was utilised to identify patients' experiences of acute deterioration. Ten databases were searched, and 249 articles were retrieved. After screening the titles and abstracts, 102 articles were assessed in full text for eligibility, and finally 23 articles were further analysed and synthesised using inductive thematic analysis. Results19 qualitative studies, three quantitative and one mixed methods study met the inclusion criteria. Seven key themes emerged related to patients' experience of acute deterioration: (1) transformation of perception: memories of factual events; (2) psychological transformation: emotional distress and well-being; (3) physiological transformation: physical distress; (4) facing death; (5) the severity of acute deterioration: from the perspective of the patient; (6) relationship with healthcare professionals and the clinical environment; and (7) the value of relationships: the support of family and friends. ConclusionsParticipants had considerable recall of their experiences and hospital admissions. The themes highlight the important issues patients face during their own acute physiological deterioration. This review has highlighted that further research is needed to specifically explore the patients' experience of acute deterioration and the emergency management they receive, for example from a hospital's rapid response team (RRT) or medical emergency team (MET).

Early termination of resuscitation in in‐hospital cardiac arrest and impact to the outcome calculations

Some in-hospital resuscitation attempts are assessed futile and terminated early on. We hypothesized that if these cases are reported separately, the true outcome of in-hospital cardiac arrest is better reflected. We conducted a 3-year prospective observational Utstein-style study in Tampere, Finland. All adult in-hospital cardiac arrests outside critical care areas attended by hospital's rapid response team were included. Resuscitation attempts that were terminated within 10 minutes were considered early terminations. The cohort consisted of 199 in-hospital cardiac arrest patients. Twenty-seven (14%) resuscitation attempts were terminated early due to the presumed futility of the attempt with median resuscitation duration of 5 (4, 7) minutes. These cases and the 172 patients with full resuscitation attempt were of comparable age, sex and comorbidity. Early terminated resuscitation attempts were more often unwitnessed (63% vs. 10%, P < .001) with initial non-shockable rhythm (100% vs. 80%, P = .006) when compared with full attempts. The most frequently reported reasons for termination decisions were non-witnessed arrest presenting asystole as initial rhythm and severe acute illness. The hospital survival with good neurological outcome and 1-year survival were 30% and 25% for the whole cohort, and 34% and 29% when early terminated resuscitation attempts were excluded. One-seventh of resuscitation attempts were terminated early on due to presumed futility of the attempt. Short- and long-term outcomes were 5% and 4% better when early terminated attempts were excluded from the outcome analyses. We believe that in-hospital cardiac arrest outcome is not as poor as repeatedly presented in the literature.

Rapid Response Team activation for pediatric patients on the acute pain service.

Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team. Two independent practitioners reviewed electronic medical records to determine which events were likely associated with pain management interventions. Over a 4-year period, 4872 patients were admitted to the acute pain service of whom 135 unique patients required Rapid Response Team consults. There were 159 unique Rapid Response Team activations among 6538 unique acute pain service consults. A subset of 27 pain management-related Rapid Response Team consultations was identified. The largest percentage of patients on the acute pain service were adolescents aged 12-17 (36%). Compared to this age group, the odds of Rapid Response Team activation were higher among infants <1year old (odds ratio=2.85; 95% confidence interval: 1.59, 5.10; P<.001) and adults over 18years (odds ratio=1.68; 95% confidence interval: 1.01, 2.80; P=.046). Identifying demographics and etiologies of acute pain service patients requiring Rapid Response Team consultations may help to identify patients at risk for clinical decompensation.

82 Experiential Value of Emergency Medicine Resident Membership on Hospital Rapid Response Team

82 Experiential Value of Emergency Medicine Resident Membership on Hospital Rapid Response Team

Abstract 258: A Novel Process to Reduce Mortality Associated with In-Hospital STEMI

Background: According to recently published data mortality due to ST-elevation myocardial infarction (STEMI) occurring in hospitalized patients (pts) can be as high as 40%. Reasons for the high mortality are not completely understood, but delays in diagnosis and treatment, as depicted by prolonged (129 minutes) diagnostic ECG to first intra-coronary balloon inflation (E2B) time, may play a major role. The hospitals of the academic health center (AHC) of Indiana University Health put in place a process for the early identification and treatment of in-hospital ST-elevation Myocardial Infarction (i-STEMI). The process went into place in August of 2009 and consisted of three simple steps: 1) bedside nurses were empowered to obtain a 12 lead ECG on any patient with signs or symptoms of acute coronary syndrome, 2) Providers from the hospital rapid response team (RRT) interpreted the ECG within 10 minutes of acquisition, 3) The rapid responders were empowered to activate the cardiac catheterization laboratory as a Level 1 STEMI emergency. Prior to launch of the i-STEMI process, multiple approaches were employed in order to ensure nurses were adequately educated. We report on the mortality results from the first 40 months of the novel process. Methods: The emergent cardiac catheterization database was queried to identify 141 hospitalized pts for whom cardiac catheterization laboratory was activated emergently between August 2009 and 2013. Electronic health records were reviewed to record demographics, admission diagnosis, comorbidities, current cardiac medications, indication for obtaining diagnostic ECG, time of diagnostic ECG, time of first intra-coronary balloon inflation, post i-STEMI ejection fraction, and discharge disposition for each patient. Results: We found 52 confirmed cases of i-STEMI out of total 141 pts. Out of 52 i-STEMI pts 49 (94%) underwent emergent coronary angiography. The reason for not performing angiography in remaining pts was increased risk of bleeding and altered mental status. Percutaneous coronary intervention (PCI) was performed in 29 (56%) pts. Reasons for not performing PCI in remaining pts included: occlusion of saphenous vein graft and absence of critical stenosis in infarct-related coronary artery as predicted by diagnostic ECG. E2B time for i-STEMI pts at our AHC was 81 minutes. Overall in-hospital mortality was 17%. In-hospital mortality in pts who received PCI was 6.6%. Our E2B time and hospital mortality were much lower when compared with recently reported data i.e. 81 minutes vs. 129 minutes and 17% vs. 40% respectively. Conclusion: A simple protocol that empowers adequately trained bedside medical personnel can significantly reduce time to optimal treatment and in-hospital mortality associated with i-STEMI. For patients who receive timely intervention, i-STEMI can be managed with survival rates very similar to pts presenting to hospital with STEMI.

Hospital rapid response team and patients with life-limiting illness: A multicentre retrospective cohort study

Background: Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. Aims: We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. Design/Setting: A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network. Results: We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness. Conclusion: Patients with a life-limiting illness had worse outcomes post–rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.

Opportunity for Pharmacy Intervention on an Urban Teaching Hospital Rapid Response Team: A Pilot Study

Background: The role of a rapid response team (RRT) or medical emergency team is to bring the expertise of specialists trained in critical care to patients on general medicine and surgical wards who are rapidly deteriorating and to treat them accordingly. The involvement of pharmacists on cardiopulmonary resuscitation teams has been reported. However, the role of a pharmacist member of an RRT has not been extensively researched. Objective: To identify the role of a pharmacist on an RRT and categorize types of pharmacist interventions during cardiopulmonary resuscitation and initial patient assessments. Methods: This pilot study documented interventions made by the pharmacist on our RRT over a 1-month period. The pharmacist assisted the RRT with evaluations of patients during assessments and cardiopulmonary resuscitations and provided specialized medical information based on our current organizational standards of practice. Results: The pharmacist attended 34 consultations and 8 resuscitations during cardiopulmonary arrests. There were 96 interventions made during 34 RRT assessments—2.6 interventions per assessment. The most common interventions were treatment recommendations (29%), dosing recommendations (15%), and procuring medications for emergent use (12%). In both the treatment and dosing categories, antibiotic recommendations were the most common. Conclusions: The pharmacist member of the RRT had the opportunity for intervention on every patient seen by the team. The most common areas for intervention are treatment and dosing recommendations involving antibiotics, as well as providing and preparing emergent medications.

Establishing a rapid response team (RRT) in an academic hospital: One year's experience

Rapid response teams and medical emergency teams have been utilized to rapidly manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions but have not been extensively described in the American medical literature. To describe a full year's experience of implementing a rapid response team (RRT) in an academic medical center. Retrospective analysis of our hospital's RRT database and description of the implementation process from July 2004 to July 2005. Urban, academic medical center. The RRT system was activated for 307 potentially unstable patients. The most common reasons for an RRT activation were cardiac, respiratory, and neurological conditions. At least 37% of RRT calls were for off-unit inpatients and to outpatient/common areas frequented by outpatients and visitors, whereas at least 42% occurred in inpatient units. Most RRT calls, 82.9%, occurred during daytime hours. In the opinion of RRT leaders 98% of the evaluated calls were appropriate and 85% of the RRT responses resulted in the prevention of further clinical deterioration. An RRT was introduced into an academic medical center, and the results suggested it is capable of preventing clinical deterioration in unstable patients and may have the potential to decrease the frequency of cardiac arrests. The RRT also may fill a gap in patient safety by enabling rapid triage and expedited treatment of off-unit inpatients, outpatients, and visitors. The keys to the early success of our implementation of an RRT were multidisciplinary input and improvements made in real time.