VHA initiates regional RRT collaborative program
VHA initiates regional RRT collaborative program
Recognition process takes note of top performers
VHA West Coast, based in El Segundo, CA, has successfully launched a regional collaborative for rapid response teams, which it has made available to 118 acute care hospitals in six states. "Our overall goal was to help our member hospitals improve their economics and quality performance through a collegial, networking collaboration in which they shared best practices," says Patricia Tyler, RN, CCRN, director of performance improvement.
VHA, in fact, has a number of such initiatives under way, but in the past year a new element has been added: a recognition process for the top hospitals. "QI is not always easy, and you don't always get a pat on the back," Tyler notes. "This program recognizes hospital teams and frontline staffs. We created several different award categories, including individual awards."
This year, says Tyler, VHA was able to present awards to 12 hospitals within the region.
Collaborating for excellence
The collaborative has been in place for about a year. Many of the facilities got together for face-to-face meetings, but four satellite sessions were held for those facilities whose representatives couldn't come on site, such as those from Hawaii and Alaska. "We had the regional meetings, national VHA Inc., support meetings, and information was also provided to them via e-mail correspondence," notes Tyler. "We also had conference calls in which members could talk and share experiences with each other. We have found the best learning takes place when hospital teams can come together and share each other's knowledge, experiences, and barriers. For instance, where one hospital might see a barrier, another may have already solved the problem."
In order for a hospital to qualify for an award, notes Tyler, they had to have participated in the collaborative. "They had to have improved from the last year to this year by a certain percentage, and submit data as part of their measurement to show improvement — to show if the interventions were making a difference," she explains. "We particularly looked at significant improvement in preventing codes outside of the ICU, decreasing unnecessary transfers to the ICU, and decreasing mortality from unexpected codes."
The facilities also were asked to identify their champions, and to share what, in many instances, were compelling stories. "This was an opportunity for them to really share what their best practices were and make it understandable and readable for other teams," Tyler explains.
Then, at the awards ceremony, the winners made brief presentations. "They felt good not only because they were being recognized for their work, but also because they were being supported and recognized amongst their colleagues from other hospitals," says Tyler. "They were able to convey a compelling message to the other teams about quality and safety."
Rapid acceptance seen
One of the award-winning facilities, Sutter Delta Medical Center in Antioch, CA, readily integrated the rapid response team program when it was launched in April 2006, recalls Darci Dumford, RRT, manager of the cardiopulmonary and cath labs. "We saw dramatic increases in the call for rapid response teams almost immediately; there were no barriers from anyone," she states. "It was a positive effort to put our patients first and get them taken care of, and it continues like that."
The Sutter Delta team includes the charge nurse from ICU and a respiratory therapist. "Anybody at all can call the team; all you need to do is have a suspicion something is not right with the patient," Dumford explains. The calls can be made for "any reason at all," she adds.
Family members can call the team as well, says Dumford. "There has not yet been an educational push to family members, but if they approach a nurse and say there has been some change in the patient's status they can call."
Housewide, there has been a "huge" educational push, with posters up in numerous areas of the facility and educational sessions for all departments.
Despite the fact that there are no restrictions on who can call — or why — there has been no problem with unnecessary calls, reports Dumford. "The whole experience is supposed to be an educational opportunity," she observes. "Even if a nurse on the floor who is not that experienced calls for a rapid response and the group arrives [and determines the call was not necessary], they work on educating that person. It's all about our focus on putting the patient first."
Setting protocols
The program at John Muir Health, Concord (CA) Campus, another award winner, was a little more structured, notes Karen Denham, RN, CCRN, director of critical care telemetry. "The medical staff got together and created a set of protocols for nurses to implement in treating the patient," she notes. "There are specified treatments for patients with chest pain, shortness of breath, and patients with very low blood pressure."
The Muir program, which launched in March 2006, also involved staff education sessions. "We had a lot of discussion about what a rapid action team was, and what its purpose was," Denham recalls.
The team is comprised of a critical care RN and a respiratory therapist, notes Rhonda Polder, RN. "Any staff member can call; we are working through the process of having families and patients call, but it's not in place yet," she reports. "We just need to make sure our communication system can support it and that we will be able to handle the increased volume of calls."
While there are specific clinical criteria, Polder is quick to point out that, "Literally, the first criteria is that you're worried." While that is a broad criteria, "We do want to make sure the team is used well and appropriately so we can support it," she adds. "It will require some patient education, and we are putting that together."
So far, she says, the response to the team has been "fabulous." She says that while they are evaluating the program, they are simultaneously conducting an RN satisfaction survey for every call that goes out. "The response has been overwhelmingly positive; it is seen as such a supportive [program for the nurses]," says Polder.
Polder notes that the collaborative model has been extremely valuable. "I think it helped us get off the ground," she asserts. "It got us the key information we needed to make sure we were responding to the right kinds of calls and that the program was implemented appropriately."
"VHA has been so helpful in connecting us in any different phase of implementation with someone who had already implemented it, and who had sustained positive results," Dumford notes. "They also provided easy access to tools someone else has used successfully."
Tyler notes that the program's benefits extend beyond the obvious patient care impact. "It also engenders an increase in nurse satisfaction and empowerment; they feel they are being supported in a team environment, and in some cases, they are learning from more experienced nurses," she says. "We're even seeing increased nurse retention because team leaders support that type of environment and culture."
For more information, contact:
Patricia Tyler, RN, CCRN, Director Performance Improvement, VHA West Coast, El Segundo, CA. Phone: (310) 726-4082. E-mail: [email protected].
Karen Denham, RN, CCRN, Director of Critical Care Telemetry, Rhonda Polder, RN, John Muir Health, Walnut Creek campus, 601 Ygnacio Valley Rd., Walnut Creek, CA 94598. Phone: (925) 939-3000.
Darci Dumford, RRT, Manager, Cardiopulmonary and Cath Laboratories, Sutter Delta Medical Center, 3901 Lone Tree Way, Antioch , CA 94509. Phone: (925) 779-7200.
VHA West Coast, based in El Segundo, CA, has successfully launched a regional collaborative for rapid response teams, which it has made available to 118 acute care hospitals in six states.Subscribe Now for Access
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