Education, Teaching, and Quality Improvement |

Implementation of a Rapid Response System: Evaluating the Effect on Rapid Response Activation and Code Rates FREE TO VIEW

Nathan Boyer, MD; John Hunninghake, MD; Shannon Womble, RN
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Brooke Army Medical Center, San Antonio, TX

Chest. 2015;148(4_MeetingAbstracts):471A. doi:10.1378/chest.2270030
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SESSION TITLE: Education, Research, and Quality Improvement

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 25, 2015 at 07:30 AM - 08:30 AM

PURPOSE: Rapid response system (RRS) development is driven by the knowledge that critical deterioration in patients is often preceded by measurable signs of physiological worsening hours prior to the event. The purpose of this study was to evaluate the impact of a formal RRS training program on call rates and code blue events.

METHODS: A quasi-experimental pre-test, post-test design was used to assess outcomes following implementation of a formal RRS at a large military medical center. RRS implementation consisted of a mandatory hour-long lecture, computer-based training, and a marketing campaign with signs/placards available on all medical and surgical wards. The Rapid Response Team (RRT) consisted of a critical care nurse and respiratory therapist with the addition of the patient’s primary nurse and responsible provider. Variables included the rate of RR calls, reason for call, code blue events outside the ICU/ED/OR, and final disposition of the call. As part of the training, an emphasis was placed on the mandatory RRT notification for any abnormal parameter. Data was gathered retrospectively (1January-August 2014) and prospectively (September-December 2014) following our intervention.

RESULTS: After the RRS training intervention, the average number of calls per month rose from 39 (17 per 1000 discharges) to 123 (58 per 1000 discharges), p<0.001. The mean number of code blue events decreased from 1.5 codes per month to zero per month, p<0.001. Reasons for RRS initiation were tachycardia (27%), hypotension (23%), and staff concern (15%). Prior to initiation, 45% of RRS calls were transferred to a higher level of care versus 34% after, p<0.003.

CONCLUSIONS: After initiation of a standardized RRS intervention, we observed significant improvement in staff awareness and patient outcomes.

CLINICAL IMPLICATIONS: Early identification of physiological deterioration with implementation of appropriate care can improve outcomes. Following our intervention, the rate of calls significantly increased, with a significant decline in code blue events and fewer transfers to the ICU. The top three etiologies for RRS initiation were tachycardia, hypotension, and staff concern.

DISCLOSURE: The following authors have nothing to disclose: Nathan Boyer, John Hunninghake, Shannon Womble

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