Hospital Policy

Purpose: National hospital data demonstrates that patients—particular those in a non-ICU setting—may be better “rescued” through implementation of “rapid response teams.” A rapid response team is a team who brings critical care expertise to the bedside. The activation of such a team has allowed hospital and medical staff teams to offset acute clinical deterioration and improve outcomes.

Team Members: The Rapid Response Team at Hospital A will consist of:

  • ICU nurse with advanced training in Rapid Response Team interventions
  • Respiratory Therapist
  • Hospitalist (by back-up beeper)

Procedure:

  1. Call Criteria:
  2. A Rapid Response Team call can be activated by any staff member (e.g. nurse, physician, respiratory therapist, occupational or physical therapist, physician assistant) who provides patient care at Hospital A.
  3. The following criteria is a GUIDELINE for initiating a call:
  4. Staff member concerned/worried about the patient
  5. Acute change in heart rate (less than 40 or greater than 130 beats per minute)
  6. Acute change in systolic blood pressure (less than 90 mm/Hg)
  7. Acute change in respiratory rate (less than 8 or greater than 24 breaths per minute) or threatened airway
  8. Acute change in blood oxygen saturation (SpO2 less than 90 percent despite oxygen)
  9. Fractional inspired oxygen (FiO2) of 50 percent or greater
  10. Acute change in mental status (delirium, confusion, etc.)
  11. Acute significant bleeding
  12. New, repeated, or prolonged seizures
  13. Failure to respond to treatment for an acute problem/symptom
  14. Role of the RRT
  15. The RRT will respond at the bedside within 5 minutes
  16. The RRT will:
  17. Assess
  18. Stabilize
  19. Assist in Communication
  20. Facilitate Transfer to higher level of care, if necessary
  21. Educate and Support
  22. RRT will document call and interventions in the call record form (see VI).
  23. For all calls in which the patient is NOT transferred to an ICU level of care, the RRT will revisit the patient within a 4 hour period of time.
  24. For all calls in which the patient IS transferred to an ICU level of care, the RRT will revisit the transferring unit within 24 hours with an educational update and follow up on the patient.
  25. Role of the Primary Nurse
  26. The primary nurse will continue to function in his/her role, even during the RRT response.
  27. Contacting the Primary Physician
  28. After initial RRT assessment--and as soon as is practical--a call should be made to the primary physician. This may occur during active stabilization of the patient by the RRT, and it is encouraged that this call be made by the primary nurse (see algorithm).
  29. Stabilization Procedures
  30. The RRT may implement any and all necessary acute adult emergency protocols (e.g. respiratory protocols, symptomatic hypotension, chest pain, critical arrhythmias, acute stroke, acute altered mental status and acute hemorrhage) as approved by the MEC is Policy # XXXXXX.
  31. Documentation
  32. Documentation of the RRT call will be made on the RRT call record form, and is kept in the medical record. The duplicate (yellow) form will be sent forward to the Quality Improvement Department.
  33. Outcomes
  34. The Quality Improvement Department, in coordination with the RRT task force, will provide the following monthly outcome data for review by Medical Executive Committee’s Hospital Quality Committee on a quarterly basis in the first year of implementation:
  35. # RRT calls/month
  36. length of time for bedside intervention by RRT
  37. % of calls requiring transfer to a higher level of care
  38. category of triggers for RRT calls
  39. % and # of codes in the non-ICU setting
  40. survival rate of codes
  41. Backup Hospitalist’s Role
  42. In the event that the RRT is already at the bedside of a patient, and a second RRT call occurs, a call will be made to the backup Hospitalist to respond within the 5 minute goal
  43. The Hospitalist will also be available for consult and potential invasive interventions (e.g. intubations, central line placement) as is necessary.

Approved by MEC 8//05

Approved by Board of Trustees 9/05