The Veterans Affairs Puget Sound Health Care System in Seattle improved the performance of its rapid response teams (RRTs) by improving staff familiarity with them. The better staff understand how to work with an RRT, the better the outcome for the patient, the leadership found.
The health system was able to decrease the average length of time for an RRT by 15%, provide updated RRT education to 91% of RNs, decrease calls greater than 35 minutes by 12%, and decrease admissions to the ICU from an RRT by 8%. The results all exceeded the project team’s goals and result in a projected annual fiscal effect of $78,112.
By the end of the project, the percentage of RRT calls lasting more than 35 minutes dropped from 47% to 35%, and the percentage of patients remaining on the floor after the call rose from 45% to 53%.
Clinicians at the health system recognized that there was room for improvement with the RRTs, says RRT member and critical care nurse Jeffrey Passey, BSN, RN, CCRN. One goal was to reduce the RRT time at the bedside, because surgical ICU staff members acted as the RRT and every minute on the RRT task was time during which someone else had to care for their own patients, Passey explains. The team also wanted to improve patient outcomes by more rapidly resolving the patient emergency, he says.
The health system utilized an RRT for 12 years, but problems had arisen in terms of the response time and disposition of the patient’s care. RRTs were sometimes spending an hour, and in some extreme cases two hours, at the patient’s bedside trying to remedy the situation, Passey says — a length of time that ran counter to the idea of a team of experts who would respond rapidly, stabilize the patient, and then return to normal duties.
Nurses Unclear on Roles
The RRT protocol was updated to ensure that a physician responded on each call, which improved the disposition of cases because a doctor’s order is always needed, Passey notes.
“We also realized that the nurses taking care of the patients on the floor were unclear about when to call in the RRT and what their responsibilities were once that team arrived,” Passey says. “They wouldn’t disappear, but they would back way off and we would find ourselves in an unfamiliar unit as a rapid responder, trying to make the best decision for the patient without all the input from the floor nurse that might have been helpful.”
The initial idea was to improve awareness of the RRT’s role and how it worked among the clinicians most likely to need it, but Passey says the team soon found out the need for education was much broader.
“It morphed into having to educate literally the entire hospital, from residents and doctors on to all the floor nurses,” he says.
The initiative kicked off with an RRT Education Fair held at the hospital with physicians, floor nurses, and the rapid responders all encouraged to attend. Turnout was good because as most project leaders learn, if you give them pizza, they will come.
Passey and his colleagues educated physicians with handouts that highlighted their responsibilities in an RRT response, emphasizing that disposition was needed in a timely manner. Floor nurses were provided similar education, backed up by rounds on night shifts to go over their responsibilities when calling for a rapid response.
“That produced real change and some significant help for the rapid responders when we showed up. We now had had help, we had information on the patient, and it streamlined the response, improving the process significantly,” Passey says.
That result came only after considerable effort, says Renae Kim, BSN, RN, an RRT member and another member of the project team. Because the RRT can be called out by so many clinicians throughout the facility, that meant a large number had to be educated — far more than with some more targeted quality improvement efforts.
“There were four members of our team, so reaching everyone on all our floors and getting them on board was a big hurdle time-wise,” Kim says. “Just getting to all of them on different shifts and with varying schedules was a challenge, and the time to provide the education adds up quickly.”
Staff Wanted Education
Passey says the RRT education was well received and that many staff said they felt starved for education on the topic and felt uncomfortable not knowing their roles in a rapid response.
“It made them nervous not knowing. When you give them the education, it empowers them,” Passey says. “Now, when I go on rapid responses I can almost come in and just supervise. The floor nurses, at least in certain areas, are almost running the response themselves and I’m there for maybe some more critical thinking and guidance for disposition.”
Kim suggests that most hospitals could benefit from this approach because she has worked on RRTs at other facilities that also did not involve bedside nurses in the rapid response, but only told them when to call for help. It is not unreasonable for the floor nurse to think the proper response is to just stand back when the “experts” arrive, she says.
“Rapid response teams typically include the critical care staff and respiratory therapists, but they generally don’t include education for the bedside nurses taking care of the patient,” Kim says. “Getting them involved and empowering them to be part of that team makes a huge difference in getting the response and disposition streamlined. In many cases, you’re going to be leaving the patient with that nurse again, so if they are involved they understand better what happened, what resolved the situation, and what the follow-through plan is.”
SOURCES
- Renae Kim, BSN, RN, Veterans Affairs Puget Sound Health Care System, Seattle. Email: [email protected].
- Jeffrey Passey, BSN, RN, CCRN, Veterans Affairs Puget Sound Health Care System, Seattle. Email: [email protected].
