An Evidence-Based Project to Redesign a Rapid Response Team

LaFaro, Maria C.

Monday, 18 November 2013

Maria C. LaFaro, DNP, RN, ANP-BC
School of Nursing, University of Rochester, Rochester, NY

Learning Objective 1: Discuss one organization’s experience with an evidence-based approach to improve patient safety through rapid response team redesign.

Learning Objective 2: Identify two factors that may enhance Rapid Response Team call volume and intensity

Background: Hospitalized patients are vulnerable to clinical deterioration and errors. There exists an inadequate response to recognize and treat critical illness in hospitals. The majority of patients who suffer cardiac arrest experience measurable clinical deterioration hours preceding the event, such deterioration is rarely reported to providers. Rapid response teams (RRTs) have been widely implemented to avoid this failure to rescue. The intensity of calls to RRTs is inversely correlated with cardiac arrest and mortality rates.

Aim: To redesign an existing but underutilized RRT in a large academic, Magnet designated, tertiary care medical center in an effort to increase call volume and intensity.

Methods: An evidence-based approach was used to formalize a dedicated, interprofessional RRT and to design a trigger-driven system (TDS) to mandate calls based on physiologic criteria and/or nurse worry. The Synergy Model of Patient Care and the Model for Evidence-Based Practice Change served as theoretical frameworks for the project. The TDS was evaluated on one inpatient unit for a period of six weeks. Rates of RRT calls were monitored and compared to rates in the same period of the preceding year, and to the rates observed in the months preceding the change.

Results: Calls to the RRT increased substantially. Before RRT formalization, institutional call rates ranged from 1.21-4.12 calls/1000 discharges (d). RRT formalization increased rates to 18.82-32.53calls/1000d, implementation of the TDS further increased rates to 30.51-37.49calls/1000d.

Conclusions: The use of research evidence, theory, and organizational experience facilitates evidence-based practice changes. Formalization of the RRT and implementation of a TDS increased call volume. Improvements in call volume should reduce failure to rescue events and improve patient outcomes. Implementation of a mandated TDS within an organization would likely require significant organizational support and infrastructure. Evidence-based formalization of the RRT may improve call volumes without the need to mandate calls.

See more of: Evidence-Based Practice Posters Session 2
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