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Outlying benefits of RRTs, can we discount those?
Reasons we like rapid response teams
Earlier intervention, a second pair of hands, and nurses love them — these are all reasons why experts Hospital Peer Review spoke with are in favor of continuing the use of rapid response teams.
While Patrice Spath, of Brown Spath Associates in Forest Grove, OR, admits she's always questioned if rapid response teams do actually improve outcomes, she doesn't discount the additional benefits RRTs can reap, and for those reasons she'd say "give it a try and gather the hard data later."
Among those benefits Spath considers the most advantageous to be interdisciplinary collaboration. "Nurses, RTs, MDs, etc. had to work through some often difficult territorial and clinical issues. When they get to the final process design, they'd learned a lot about one another's role on the patient care team and how best to tap into the value each discipline brings to the table," she says.
"That exercise, if done right, was a culture-changing activity for the organization. Even if patient mortality does not significantly decrease, the organization benefited."
She's concerned, though, when something becomes a standard or, as with The Joint Commission, an example of meeting a standard, "before there is good evidence to support it. Plaintiff attorneys start salivating every time something starts sounding like a patient care standard — it's another potential legal weapon regardless of the lack of scientific evidence."
Another thing about rapid response teams that experts HPR spoke with agree on is that nurses love them. "The nurses love it because they feel when they need help, they can get it. That tells me we've got a broken chain of command policy." Spath says, two years ago, if a nurse needed help, she could get it and wasn't encouraged to ask for help. With a rapid response team in place, nurses should be, and in many cases are, encouraged to ask for help when they feel they need it or when they see signs of a patient deteriorating.
"I do think having something 'official' makes it OK to ask for help," Spath says. "And health care professionals, from physicians to nurses to on down [the ladder], are not rewarded for asking for help."
"The staff have an alternative," says Patti Muller-Smith, RN, EdD, CPHQ, a Shawnee, OK-based consultant who works with hospitals on performance improvement and regulatory compliance. "And I think that that is probably one of the greatest benefits of [the rapid response teams]. If they look at a patient and feel that patient is not responding the way they would like, or the patient has respiratory or cardiac difficulties, then rather than calling a whole code, they can call the rapid response team to evaluate the patient before they do anything."
She points out that when a full code blue is called, many hospitals incur an extra charge, whereas if an RRT is activated, a full code may not have to be made. "If you're looking at dollars and cents and you look at the expense of having to do a code blue, there's probably some reduction in costs."
While the authors of the recent JAMA study call into question the cost of installing a rapid response team, there is no clear information on average costs of an RRT. Experts HPR spoke with say in many cases, there is no cost for additional staff, as most of those are already in the hospital.
Spath also points to where the RRTs are being used in the hospital. Rarely is there a team for the ICU. But don't ICU nurses need help as well? she asks. As far as their effectiveness, she says the original intent was to reduce the number of codes on the general nursing unit. And if that, in addition to providing other staff with help, becomes your goal, than an RRT could help.
Paul S. Chan, MD, MSc, of the Mid America Heart Institute and the University of Missouri, lead author of the JAMA study, notes the benefits of the rapid response team intervention. Standing behind the study findings, Chan says while this was not measured by the intent of the study, "There's clearly a high level of satisfaction with nurses, and the use of interdisciplinary collaboration on rapid response teams is to be lauded."
And most of those HPR spoke with are in favor of both continuing to use RRTs and to continue studying the effects of the intervention. They pose this question. If you were a patient in a hospital, would you rather be at a facility that has a rapid response team or one that doesn't? Their answer, most resoundingly, was yes.