Rapid response systems or teams have been deployed in many hospitals with the goals of preventing intensive care unit transfer, cardiac arrest, and/or death (Agency for Healthcare Research and Quality, n.d.). One study demonstrated a 35% reduction in FTR after implementing a standardized rapid response system (Chen, et al., 2016). Challenges may exist with escalation of care and the deployment of rapid response teams, however. This may be due to a variety of system or culture barriers, or differences in perception. Study findings by Stolldorf (2016) highlight the variation in perceptions of rapid response teams when comparing nurse leaders, rapid response team members, and rapid response team users. Examples of barriers to RRT utilization include fear of hierarchy, intimidation, or criticism (Johnston et al., 2016). In one study in which staff from 40 acute care areas in a large hospital were surveyed, staff reported reluctance to activate the team if the patient’s vital signs were normal. A perceived barrier in this study was also fear of criticism (Douglas, et al., 2016). In another qualitative study, activating the rapid response team was influenced by whether the patient was exhibiting subtle versus abrupt changes, as well as informal social rules: hierarchy and fear of criticism (Braaten, 2015).
Description: An opportunity for improvement was identified in an academic medical center in Southeast Texas in the prompt identification of patients experiencing adverse events with concurrent activation of the medical-surgical rapid response team (RRT). Anecdotal reports of patients deteriorating for multiple hours before requesting additional help was concerning. As an example, one patient with severe hypoglycemia experienced a delay in escalation for many hours. In retrospective reviews of cardiopulmonary arrest events, instances of failure to rescue were also noted.
An adult critical care bedside clinician (also a member of the rapid response team) partnered with the adult critical care Clinical Nurse Specialist to implement a plan to improve rapid response team utilization. The strategy was frequent communication to medical-surgical bedside clinicians in the form of a regular newsletter. This project’s intent was to educate nurses, and raise awareness regarding the importance of activating the rapid response team early and often. Additionally- the newsletter was designed to be short in length (quick/easy to read), colorful, and visually interesting.
In the fall of 2016, the first newsletter was published and disseminated electronically to all inpatient nurses. The newsletter features several sections. The first section of each publication is titled “Spotlight”. Topics are rotated each month. One example is a brief overview of a disease or condition, such as heart disease and kidney disease. One frequent spotlight topic is the introduction of new staff when they become members of the rapid response team. The background of the individual is reviewed, as well as their professional and personal interests. A photo is included for visual recognition. This topic was deemed important in order to “humanize” individual responders in an effort to “demystify” the rapid response team system.
Case reports are also a routine feature in the newsletter. These reports are summaries of actual rapid response calls. They are discussed and summarized to help educate staff on examples of scenarios to request additional assistance for patients. Some reports highlight the importance of bedside nurses who used their clinical instincts with subtle changes, in order to encourage future similar calls. Detailed patient information is de-identified to address regulatory concerns related to privacy. A third section of the newsletter is titled “Cranium Challenge” and consists of a quiz with few questions to challenge bedside nurses on different aspects of patient care. Examples include signs and symptoms and pathophysiologic changes associated with disease conditions, and anticipated effects of medications. Answers to the quiz questions are at the bottom of the newsletter for immediate validation and/or learning.
Finally, each newsletter contains repetitive information and instructions. These include criteria for activation, instructions on how to activate the team, and who to contact for non-urgent questions or additional information. The presence of this information in each newsletter is intended to increase awareness and as a frequent reminder.
Evaluation: Over a 2 year period before and after the implementation of the newsletter, rapid response activation calls in the academic medical center increased by 31 percent. Failure to rescue findings in retrospective code reviews are now infrequent. These findings are an encouraging trend in an effort to increase utilization of the rapid response team and improve outcomes.
Implications: The success and simplicity of this approach has far-reaching implications for reproducibility. Nurses working in hospitals locally, regionally, and worldwide, can share innovative best practices and play an instrumental role in improving prompt identification of adverse patient events, rapid response team utilization, and ultimately patient outcomes. Finally, this project is congruent with the conference theme Innovating Healthy Clinical and Academic Environments: Optimizing Patient Outcomes and Professional Well-Being.