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Authors

  1. Costello, Arlene RN, CNAA, MS

Article Content

The positive impact of the implementation of rapid response teams (RRTs) was validated last year when The Joint Commission included as goal 16 of its 2008 National Patient Safety Goals: "Improve recognition and response to changes in a patient's condition." As part of that goal, it's expected that "the organization selects a suitable method that enables healthcare staff members to directly request additional assistance from a specially trained individual(s) when the patient's condition appears to be worsening."1 One way of meeting this goal is through implementation of an RRT.

 

In this article, the successful implementation of an RRT at a 437-bed community teaching hospital is discussed and the potential for using the presence of an RRT to improve recruitment and retention is explored.

 

Implementation

The implementation of an RRT involves bringing critical care expertise to the bedside promptly based on complete and concise information and ultimately building the strengths and confidence of the bedside nurse. The Institute for Healthcare Improvement (IHI) defines the role of the RRT to include assessment, stabilization, and communication, as well as education and support. The clinical outcomes of RRTs are well documented within the literature, with some hospitals reporting a reduction in cardiac arrests outside the ICU by as much as 25% to 50%.2 Equally important, but not as easily quantified, is the effect of the presence of an RRT on the nurse. The RRT should be perceived as a collaboration and consultation between the nursing staff and a resource for learning and improving clinical skills in preemergent situations. It also provides social support to the nursing staff while building strong collegial relationships.

 

When establishing an RRT initiative at our institution, a 437-bed community teaching hospital, the team sought to incorporate the IHI's goals into the role of the RRT: "Assess, stabilize, assist with communication, educate, and support, as well as assistance with transfer if necessary." Physician's assistants, respiratory therapists, and Advanced Cardiac Life Support trained clinical nurse specialists and nurse educators were chosen as team members. Twelve months after the go-live date at our institution, the clinical outcomes of the initiative were readily apparent. Although not matching the 25% to 50% decrease in codes outside the ICU reported by the IHI, our institution reported a 12.8% decrease. Twenty-six percent of our RRT calls resulted in a transfer to a higher level of care. Additionally, we reported downward trends in both codes per 1,000 discharges and total unadjusted hospital deaths. Respiratory issues represented the majority of the calls, and the nursing unit that had the most rapid response calls reported a 33% decrease in codes per 1,000 days.

 

Success stories such as ours continue to be reported in critical care, nursing, and medical literature. However, little is reported on nurse satisfaction and the impact that an RRT can have on nursing recruitment and retention.

 

Measuring success

Following the review of the first 12 months of the RRT at our hospital, the organizing group sought to measure the success of the initiative related to education and support of the nursing staff. A Likert scale survey (1 to 5, strongly disagree to strongly agree) was distributed to all units that had five or more RRT calls during the previous 12 months. Nurse managers were asked to distribute the tool to four RNs from the day shift and four from the night shift. Seventy completed surveys were received, representing a 97% response rate. When asked if they felt that patient outcomes had improved because of the RRT, 99% of the surveyed nurses either agreed or strongly agreed (Figure 1). Additionally, 82% of the same group agreed or strongly agreed that they had been supported in their decision to call a rapid response (Figure 2), and 81% agreed or strongly agreed that they had received both support and education from the RRT members (Figure 3).

  
Figure 1: Patient ou... - Click to enlarge in new windowFigure 1: Patient outcomes have improved because of the RRT
 
Figure 2: Team membe... - Click to enlarge in new windowFigure 2: Team members are supportive of my decision to call a rapid response
 
Figure 3: I receive ... - Click to enlarge in new windowFigure 3: I receive support and education from the members of the team

Recruitment and retention potential

Just what implications do these data have for RN recruitment and retention? The clinical and financial effects of the current and looming nursing shortages are well documented within the literature. Hospitals are continually looking at ways to attract and retain these valuable resources. Kathy Duncan, RN, a faculty expert on RRTs for IHI, states, "Frustration and the accompanying fear of making a mistake is likely one of the reasons that a 2001 report published in Health Affairs found that about a third of nurses under the age of 30 reported plans to leave their hospital nursing jobs within a year."2 She speculates that the support of an RRT might be the antidote to the frustration many new nurses feel when "we throw them out there with several sick patients and no tools to help them take care of those patients."2 Seasoned nurses acknowledge that the rapid response concept draws on the kind of collaboration that has always been part of the profession, but that has been harder to maintain as nurses have gotten busier with more and sicker patients. Having a team of specially trained providers immediately accessible in challenging clinical situations helps create a safe environment in which issues and concerns can be addressed. Nurses find it empowering to have the ability to activate the RRT simply because the patient doesn't look good. Previously, nurses reported that standing by a deteriorating patient, in the absence of an RRT, was a major stressor and cause of career dissatisfaction.

 

Social support and clinical guidance have long been identified as important aspects in the transition from student to RN. Many new graduates fear isolation and are often hired to shifts for which there are less available resources on the unit. The presence of an RRT can provide the critical support and guidance to both novice and seasoned staff. When surveyed within 3 months of their hire date, eight of 10 graduate nurses hired to our institution and working on medical-surgical units answered that they wouldn't consider working at a hospital that didn't have an RRT.

 

Consider an RRT initiative

The presence of an RRT should be utilized as a recruitment tool in advertising and discussed during the interview process. Nursing programs should introduce the RRT concept to perspective graduates so they can inquire about this benefit when looking for a job and choosing an employer. Institutions suffering from the nursing shortage and experiencing an ongoing loss of RNs should consider implementation of RRTs, and those hospitals who've already implemented such teams must remain committed to the initiative.

 

REFERENCES

 

1. The Joint Commission. 2008 National Patient Safety Goals. http://www.jcrinc.com/common/PDFs/fpdfs/pubs/pdfs/JCReqs/JCP-07-07-S1.pdf. [Context Link]

 

2. Institute for Healthcare Improvement. Rapid response teams: reducing codes and raising morale. http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/ImprovementStories/FSRa. [Context Link]