ARTICLE REVIEW
Rapid Response Teams (RRTs) were introduced to bring critical interventions to the patient bedside at the first sign of deterioration. The rationale was based on the findings that caregivers outside of the ICU were often unable to recognise early signs in the deteriorating patient, or waited too long to call for assistance to prevent a code blue situation (cardiac arrest).
In the article, Avis et al (2016) [1] discuss results from previous studies [2,3], which debate whether RRT's improve patient outcomes and mortality. This debate has been explored recently in three papers published in a series by Intensive Care Medicine in 2016 [4,5,6].
The authors describe their experiences of introducing an RRT in 2006 at the Thomas Jefferson University Hospital in Philadelphia. Initially this began as a team of intensive care unit (ICU) nurses working a routine shift on the ICU's, who responded to activations despite being assigned to patient care.
Subsequently they moved to a model where four ICU nurses were allocated solely to the RRT, not only responding to activations but also proactively rounding in patient care areas other than the ICU's to help identify deteriorating patients and intervene early. They were tasked with educating hospital staff about deteriorating patients and critical care interventions. The documentation of activations became the responsibility of the RRT, which improved the completeness and accuracy of data collected. Eventually the documentation was improved to capture more data such as patient progress.
The team shared many of the difficulties described in the cited literature when implementing their RRT such as conflict between nurses and physicians, tension between ICU nurses and the bedside nurse.
Although the authors do not give exact figures, they demonstrate their results on a graph showing a reduction in code blues outside the ICU from approximately 1.75 to 0.75 per 1000 patient days. Intubations reduced from 1.0 to 0.6 per 1000 patient days. This is associated with an increase in team activation from 2.75 to 4.25 per 1000 patient days. The authors noted that the RRT redesign seemed to cause a change in the hospital culture wherein RRT interventions were no longer viewed as negative and found that they provided more open channels of communication between the MDT and families.
Avis et al attributed their success to their multidisciplinary approach and support from nursing administration and commented that ongoing commitment is required from the hospital to support RRT nurses and education in the hospital regarding their role.
Their experience supports the evidence that nurse-led RRTs improve patient mortality and decreases non ICU code blues and emergent intubations, and RRTs improve patient care by improving team communication and collaboration. However, results regarding a change in practice over time must be interpreted with caution as it is difficult to account for other confounding factors influencing practice and outcomes.
Article review submitted by ESICM Journal Review Club member Sian Birch on behalf of the N&AHP.
References
1. Avis E, Grant L, Reilly E, Foy M, et al. (2016) Rapid Response Teams Decreasing Intubation and Code Blue Rates Outside the Intensive Care Unit. Crit Care Nurse 2016;36:86-90.
2. Chen, J., Ou, L., Hillman, K. M., Flabouris, A., Bellomo, R., Hollis, S. J., & Assareh, H. (2014). Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion. The Medical Journal of Australia, 201(3), 167–170.
3. Karpman, C., Keegan, M. T., Jensen, J. B., Bauer, P. R., Brown, D. R., & Afessa, B. (2013). The Impact of Rapid Response Team on Outcome of Patients Transferred From the Ward to the ICU. Critical Care Medicine, 41(10), 2284–2291.
4. Jones, D., Rubulotta, F., & Welch, J. (2016). Rapid response teams improve outcomes: yes. Intensive Care Medicine, 1–3.
5. Maharaj, R., & Stelfox, H. T. (2016). Rapid response teams improve outcomes: no. Intensive Care Medicine, 1–3.
6. Wendon, J., Hodgson, C., & Bellomo, R. (2016). Rapid response teams improve outcomes: we are not sure. Intensive Care Medicine, 1–3.
