SESSION TITLE: Education, Research, and Quality Improvement 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: RRTs are units of skilled healthcare providers that respond to inpatient calls of clinical concern to assess, triage, and intervene on deteriorating patients. RRTs have become ubiquitous throughout the United States (US), despite equivocal data on outcomes and a lack of standardization. While most studies on RRTs investigate outcomes, no studies in the US have explored the structure or procedure of RRTs. We sought to describe the composition, leadership, and activation criteria of RRTs with hopes of shedding light on the status quo and possible areas for improvement. METHODS: The study was approved by the New York University School of Medicine’s Institutional Review Board. Acute care hospitals in New York, Pennsylvania, New Jersey, Rhode Island, and Vermont were contacted by study team members and asked to complete an online survey. RESULTS: Out of 378 hospitals, contacts were identified for 303, and 101 surveys were completed. All 101 hospitals had a RRT, 100 of which were available 24 hours a day and 73% of which changed members daily. Reason for activation and team composition varied widely. The most common reasons for RRT activation were clinical concern (96%) and a single vital sign abnormality (74%). Only 57% of RRTs used a scale such as an Early Warning Score to raise critical concern and call the RRT. The most common specialties present at RRTs were respiratory therapy (88%), critical care nursing (75%), and nurse managers (49%). Only 64% of RRTs always had a physician present, 40% always had an attending physician present, and attending physicians were never part of 9% of the teams. Critical care physicians were always present at 20% of RRTs and a physician likely to have advanced airway skills (critical care or anesthesia) was always present in only 30%. In 51% of the 63 hospitals with an internal medicine residency, residents led the RRTs and were routinely supervised by an internal medicine attending only 19% of the time. CONCLUSIONS: Understanding RRT composition and activation criteria is crucial to improving performance. The best outcomes will occur when RRTs are called efficiently, led by experienced clinicians, and comprised of skilled team players. It is likely factors such as these, and not solely the presence of the RRT, that determines success and patient outcomes. As the largest study to date on RRTs in the US, we have demonstrated wide variability in practice and a concerning lack of attending supervision and advanced airway skills in critical situations. CLINICAL IMPLICATIONS: The heterogeneity among RRTs likely contributes to the mixed outcomes noted in studies. Understanding the details of delivering ICU level care to the bedside is the first step to identifying space for improvement and warrants further investigation. DISCLOSURES: No relevant relationships by Laura Evans, source=Web Response Speaker/Speaker's Bureau relationship with Zoll Please note: $1001 - $5000 Added 03/02/2018 by james horowitz, source=Web Response, value=Honoraria No relevant relationships by Oscar Mitchell, source=Web Response No relevant relationships by Caroline Motschwiller, source=Web Response No relevant relationships by Vikramjit Mukherjee, source=Web Response
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May 30, 2019
Lauren E Vanderpool + 3
Open Access