Rapid Response Teams: Evidence of a Broader Impact that Influences Morale and Nursing Workload

Abstract & Commentary

By Leslie A. Hoffman, RN, PhD, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh. Leslie A. Hoffman reports no financial relationships relevant to this field of study.

This article originally appeared in the January 2013 issue of Critical Care Alert. It was edited by David J. Pierson, MD, and peer reviewed by William Thompson, MD. Dr. Pierson is Professor Emeritus, Pulmonary and Critical Care Medicine, University of Washington, Seattle, and Dr. Thompson is Associate Professor of Medicine, University of Washington, Seattle. Drs. Pierson and Thompson report no financial relationships relevant to this field of study.

Synopsis: Advantages of a rapid response team extended beyond a reduction in codes to impact multiple endpoints, including positive effects on nurse morale and empowerment, unit workload, and education.

Source: Benin AL, et al. Defining impact of a rapid response team: Qualitative study with nurses, physicians and hospital administrators. BMJ Qual Saf 2012;21:391-398.

In this study, the authors sought to elicit perceptions of the impact of a rapid response team (RRT) by interviewing care providers. The study was conducted at the Yale New Haven Hospital where the RRT covered 43 patient care units. The team was comprised of a rotating hospitalist physician, critical care nurse, and respiratory therapist. Those interviewed included 49 participants (16 physicians, 22 nurses, eight administrators, and three respiratory therapists). Nurses viewed the RRT as providing a sense of security and empowerment, resulting from knowing they could summon help immediately. As noted by one nurse, “It’s very comforting to have someone who can help assess the patient, determine if they are too sick to remain on the unit, and support us.” Nurses valued being able to call the RRT if “something did not seem right,” even if ill defined. Hospitalists had divergent opinions: Some valued the opportunity to keep skills current through exposure to an unstable, decompensating patient, whereas others found the need to respond to calls “extremely disruptive” and a “huge stressor” that diverted time and attention from their caseload. One benefit was unexpected: Housestaff and nurses valued RRT calls as a means to realign their workload and give more attention to other assigned patients. As one nurse noted, “I’m focusing on one patient and hurting four other patients. I called in another nurse and now her four patients are also not seeing the care they need.” Administrators viewed the RRT as a means to appropriately triage patients to the ICU, as well as a means to avert ICU transfers when appropriate, and to play an important role in nurse retention and improving nurse morale.

Commentary

RRTs were introduced to provide a hospital-wide mechanism for bringing critical care expertise to patients who developed unexpected, potentially life-threatening clinical deterioration. Although initial studies showed a beneficial effect, subsequent studies failed to confirm these findings, leading to questions about the need for this resource. In these studies, “outcome” was typically evaluated by pre/post cardiac arrest and mortality data. Findings of this study suggest more subtle benefits that translate to all patients on the clinical unit where the call is placed. Nurses valued the ability to summon a highly experienced team, allowing the team to manage the unstable patient and thus redirect attention to other assigned patients they had neglected. Housestaff mentioned the same advantage, particularly on nights and weekends when faced with multiple admissions plus a highly unstable patient who required 1:1 attention. Administrators supported positive views, citing the RRT as a means to improve patient flow and nurse retention. There were also negative opinions that cited workload disruption, potential negative impact on housestaff education, and conflicts regarding how care should be provided. Findings of this study support the need to evaluate the impact of RRT in ways that extend beyond codes and mortality.