Our hospital sought to decrease unwitnessed arrests and their attendant morbidity and mortality by implementing a rapid response team (RRT) to intervene earlier in the course of a patient’s declining clinical status. A challenge to the implementation of RRTs in the setting of teaching hospitals has been coping with the multiple layers and skill levels of physician caregivers involved in responding to patient care needs. We describe our experience with initiating an RRT under such circumstances.
An RRT committee consisting of medical and surgical critical care physicians, hospitalists, critical care nurses, and respiratory therapists developed guidelines for triggering a rapid response event. Any caregiver may activate the RRT via a specific pager. Initial responders include a critical care nurse and respiratory therapist. Simultaneously, the on call resident and the patient’s attending physician are notified. Attending physicians may also request the presence of an intensivist.
In the first quarter of the program there were 77 RRT deployments involving 69 patients. The RRT was deployed to all units and areas of the hospital, including the lobby. The majority of events were triggered by respiratory symptoms (45%),diminished level of consciousness (33%), and hypotension (17%). 55 episodes (71%) resulted in moving the patient to an increased level of care, 7(13%) to telemetry and 48(87%) to ICU. 4 patients remain in hospital; 3 were not admitted; 62 were discharged or died. Of the latter group, 48(77%) survived to discharge. 6 patients progressed to arrest during RRT deployment; 4(67%) survived to discharge (vs. 27% overall arrest survival to discharge in preceding year). Crude overall weekly hospital mortality decreased from 3.8% to 1.9% during the quarter (p=0.029).
Assuring attending physician involvement with a multidisciplinary approach allowed the RRT to efficiently care for patients with deteriorating clinical status in a university teaching hospital.
The RRT potentially identifies critically ill patients at an earlier stage of their course when intervention can have significant impact on survival. As a result, crude hospital mortality may improve.
Alexis Meredith, None.