Rapid Response Team RRT

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Rapid Response TeamRRT

• What is RRT
• A Team designed for early intervention for
  potentially unstable patients
• A Proactive approach to patient care
• Who makes up the RRT
• Varies Widely
• Nurses
• Respiratory Therapists
• Physicians (Attendings, Fellows Residents)

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Research Findings

• Majority of patients who arrest in the hospital
  have signs of deterioration for 6-8 hours
• Saves Lives
• Reduces LOS
• Calls for RRTs doubles after the 1st year
  implementation
• 30 decrease in cardiopulmonary arrests in one
  documented study.
• Approximately 40 of patients survive to
  discharge following RRT activation

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Research Findings contd

• Expedites DNR decisions in appropriate cases
• Often only simple interventions needed
• One of 8-1600s RRT calls found a patient was on
  3xs glucophage, admission was avoided with
  medication adjustment
• Facilitates staff education

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Suggested Criteria for Initiating RRT

• Evidence-based literature findings
• Initial call should be made to appropriate
  covering physician or team prior to initiating
  RRT call
• Staff member worried about the patient
• Inadequate or untimely response from covering
  team

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Criteria contd

• Acute Change in
• Heart Rate lt40 or gt 130
• SBP lt 90 mm Hg
• RR lt8 or gt30
• O2Sat lt90
• Mental Status (LOC)
• UO lt 50 ml/hr

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Top 5 Interventions for RRT Calls

• Oxygen therapy
• Non-invasive positive pressure ventilation by
  mask or ventilator
• Nebulizer treatments
• IV fluid bolus required
• Lasix administered

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Potential Economic Benefit

• Conservatively ICU care costs 2,000-3,000/day
• If 10 of admissions avoided and 10 of those
  patients admitted to ICU have shortened LOS we
  would save 5,500 ICU days. Results in
  11,000,000 savings
• Opens up additional ICU beds for patients
  requiring admission.
• Facilitates more timely admissions from the
  Floor, ED, PACU and outside transfers

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MICU RRT Experience

• MICU Responders
• Charge Nurse
• Resident (Fellow/Attending)
• Started July 2003 on 2 units, gradually increased
  to 6 units (medical)
• From July 2003-May 2004 24 calls, 15 admissions
  (42.4 saved ICU admissions)
• 57.6 of patients admitted after a RRT response
  had 1.4 days less ICU LOS

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MICU Experience contd

• Top 3 Primary events for calls made
• Respiratory Distress
• Hypotension
• Change in LOC
• Time Investment
• 10-60 minutes per call

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Rapid Response Team
1
2
1
1
1 Staff Education 2 RRT Model modified/Education
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Barriers

• Late Callsnear arrest
• Units initially hesitant to call for help
• Concern about floor physician/ICU physician
  conflict
• Floor nurses concerned about going over
  someones head
• Limitation of resourcesusing stressed resources
• Documentation of event
• No documentation from requesting units
• Inconsistent documentation from responders

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PLAN

• Modify RRT Model
• Responders are now ICU Charge Nurse and
  Respiratory Therapy Supervisor.
  Attending/Resident/Fellow/NP will respond when
  appropriate and requested by the RRT
• Educate
• RRT Presentation to Leadership and Staff
• Collect Data
• Ongoing collection
• Analyze and track trends
• Evaluate and Report
• Effectiveness of RRT
• Barriers
• Patient outcomes

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