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Education, Teaching, and Quality Improvement |

Improving Primary Team Engagement During Rapid Response Team Activations

Alice Gallo de Moraes; Gina Iacovella, MS; Ronaldo Sevilla Berrios; John O'Horo, MPH; Jennifer Elmer, RN; Sean Caples; Jeffrey Jensen
Author and Funding Information

Critical Care Medicine, Mayo Clinic, Rochester, MN


Chest. 2014;146(4_MeetingAbstracts):495A. doi:10.1378/chest.1993656
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Patients admitted to general wards often suffer clinical deteriorations that can lead to grave consequences without interventions. There are often clinical signs/symptoms that occur prior to patient decompensation that merit medical response. Previous studies have demonstrated that Rapid Response Teams (RRT) reduce non-intensive care unit (ICU) cardiorespiratory arrest, improve hospital mortality, and facilitate transfer to higher level of care. At our institution, we found that patient care during RRT activations is enhanced by the presence of the primary team. Their participation provides essential patient familiarity and continuity that is necessary during a stressful situation. We launched a quality improvement project aimed at enhancing the rate at which primary services attend RRT activations.

METHODS: Initial data demonstrated that primary teams were absent at 52% and 13% of RRT activations on patients admitted to surgical and medical teams respectively. A survey designed to identify the main barriers of primary team attendance was distributed to trainees and nursing staff. Uncertainty about when to activate RRT, inconsistent primary team contact, and failure to identify the primary team as an essential part of the RRT team were the main obstacles identified. As a result, formal education focusing on primary team and nursing expectations during RRT activations occurred through lectures, posters and e-mails.

RESULTS: Following our intervention, there was an improvement in primary team notification of RRT activations, 89% to 98% in medical and 64% to 93% in surgical services. Primary team absence decreased by 14% in surgical (down to 38%) and 6% in medical RRT activations (down to 7%). There were 5% more patients (57% pre-education vs. 62% post-education; p>0.05) requiring transfer to a higher level of care.

CONCLUSIONS: These preliminary data identified the barriers preventing primary teams from attending RRT activations. Formal education aimed at resolving these barriers resulted in improved primary team notification and attendance at RRT activations without an associated increase in transfers to higher level of care.

CLINICAL IMPLICATIONS: Education can improve primary team engagement care during rapid response team activations, and facilitate transfers of care.

DISCLOSURE: The following authors have nothing to disclose: Alice Gallo de Moraes, Gina Iacovella, Ronaldo Sevilla Berrios, John OHoro, Jennifer Elmer, Sean Caples, Jeffrey Jensen

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