Our institution formally implemented the Rapid Response Team (RRT) in January 2005. A concerted effort to educate hospital staff and physicians was performed. Despite 3 years of effort, anectodal evidence suggested that the RRT was under-utilized. The purpose of this project was to identify possible barriers to optimal RRT use.
The study design was an anonymous, internet based survey. A link to the survey was sent via Email to all physicians-in-training at our institution. Additionally, links were placed on hospital workstations in patient care units. Survey respondents were asked to agree or disagree if the presence of an event was an indication to call a RRT. Responses that agreed with institutionally defined criteria for calling RRTs were considered correct. All other responses were considered incorrect. Categorical data was analyzed using Pearson chi-squared test using SPSS software. Approval for the project was granted by our institutional IRB.
Correct responses ranged from 33.42% to 72.78% per criteria. Doctors were more likely to correctly identify the criteria than nurses or allied staff.We also explored possible reasons why staff may not call RRTs despite wanting to (11.3%). Multiple responses were permitted. Prohibition by the patient's attending or ICU evaluator, contacting the PMD, and calling the ICU were cited 47 times. 13 felt that they could manage the patient themselves while 28 said the patient's condition improved. Only 3 reported that they were unsure of the RRT criteria while 1 did not know how to call for an RRT.
RRT effectiveness has not been demonstrated in large clinical trials despite several limited studies. One factor may be due to suboptimal use of RRTs. Our study suggests that staff understanding of RRT criteria varies and that they may not be aware of their lack of knowledge.
Barriers to optimal RRT use may include the traditional medical hierarchy. Targetted interventions may be required to overcome this and to encourage more RRT calls by non-physician staff.
Calvin Hwang, No Financial Disclosure Information; No Product/Research Disclosure Information