Creating a Healthy Work Environment Using a Rapid Response System

Rapid Response Systems (RRS) have been promoted as a safety intervention for patient’s experiencing clinical deterioration. Commonly published outcome measures for RRS include decreased rates of cardiac arrests outside ICU and reduced unplanned transfers into ICU. Literature clearly describes barriers to staff initiation of RRS including recognition of clinical deterioration, fear of triggering hospital-wide systems, and emotional distress in activating RRS unnecessarily. Less commonly published outcomes describe the expert clinical support provided by RRS to novice staff, prevention of adverse events, and quality improvement opportunities discovered by RRS.

The purpose of this multiphase study was to measure staff perceptions of the Rapid Response Team ten years after its initial implementation to inform practice changes for implementation of a pilot 24/7 Rapid Response Nurse to support RRS.

The research questions we sought to answer through the survey were related to activation, effectiveness, teamwork, and communication during RRS activations. The Rapid Response System Staff Knowledge and Satisfaction Survey instrument was used to measure staff perception about the RRS. An online survey program was open for an 8-week period for data collection.

Phase 1 survey results demonstrated significant differences between ICU nurses and floor caller responses for two of the 29 survey items. ICU nurses (94%) reported significantly higher confidence in activating the RRS than floor callers (76%), X² (2, N = 215) = 12.88, p = .002. Other findings showed that significantly more ICU nurses (86%) vs floor callers (67%) disagreed that Rapid Response calls are required because management of the patient by nurses is inadequate X² (2, N = 213) = 10.71, p = .005. Both of these findings suggest that floor nurses lack of confidence in identifying clinically deteriorating patients and activating the RRS.

After the survey results were reviewed, the information was used as part of the 24/7 Rapid Response Nurse implementation plan. In this phase, a pilot proactive rounding program was developed for the specially trained Rapid Response Nurses to identify and assess high risk patients and to support floor nursing teams to implement early interventions and prevent further patient deterioration or transfer the patient to a higher level of care.

In the first 6 months after implementation of the 24/7 RRS resuscitation events outside ICU have decreased from 10.5/1000 to 2.7/1000 demonstrating a 74% decrease in resuscitation events outside ICU. Resuscitation events inside ICU decreased from 7.8/1000 to 5.0/1000 over the same period. The Risk Adjusted Mortality Index decreased from 0.85 to 0.77.

In conjunction with Rapid Response Nurse pilot program, a continuous quality improvement program was initiated to support frontline in removing barriers to optimal patient care delivery. Improvement in peer group ranking for Hospital Survey of Patient Safety (HSOPS) also indicates a positive shift in cultural change related to communication openness, non-punitive response to errors, and frequency of events reported over the past eighteen months. The Rapid Response System Staff Knowledge and Satisfaction Survey will be sent out again this year to reevaluate staff needs and to develop the program further.

In summary, the Rapid Response System seems to be a valuable patient safety program that provides support to patients, families, and frontline staff.