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This article appeared in The Home News Tribune Online
September 25,2007
A fresh set of eyes that save lives
By Thomas H. Finer, RN
Correspondent
The 77-year-old woman had just finished physical therapy. and her daughter was visiting her in the hospital. Her nurse had noticed beads of perspiration on her forehead. When the nurse asked the woman a question, she seemed confused.
The nurse knew something was wrong and activated a special response team. Three pagers began to hum. In minutes, the hospital's Rapid Response Team was at that patient's bedside.
The woman's condition was indeed deteriorating. Her blood pressure had fallen, and she was cold and clammy. The response team, made up of a respiratory therapist, critical-care nurse and house physician, gave her medicine to raise the pressure. She was intubated to help her breathe and then taken to the Critical Care Unit.
When the woman was discharged from the hospital a few weeks later, her daughter, who is a nurse, sent the team members a card that I will always cherish.
"Our family had a beautiful Christmas holiday because the Rapid Response Team saved my mother's life," she wrote. "She wouldn't be here today without the team."
A Rapid Response Team is a crisis team designed to identify patients before they "code" with cardiac or respiratory distress. The use of Rapid Response Teams is based on research showing that patients often exhibit signs and symptoms of instability hours before they go into cardiac or respiratory arrest. The idea of Rapid Response is to intervene early, well before a crisis occurs.
The call to the special team comes from the bedside nurse because she or he is in the best position to catch the early warning signs. Taking the rapid response approach a step further,some hospitals have now empowered family members and patients to summon the Rapid Response Team, believing they are also in the best position to know when something is going wrong.
The Rapid Response Team approach was pioneered in Australia. Today, more than 2,000 US hospitals have pledged to implement it as part of the Institute for Healthcare Improvement's 100,000 Lives Campaign to improve healthcare safety.
While it's up to individual hospitals to decide whether to have Rapid Response Teams, the Joint Commission, a non profit organization that accredits hospitals, has made early recognition and response a patient safety goal.
Robert Wood Johnson University Hospital at Rahway launched its Rapid Response Team in October 2005 as part of a collaborative organized by the New Jersey Hospital Association. More than 45 other hospitals across the state participated in the project.
Reassurance is important
When we started Rapid Response, we had to reassure staff that the team would not descend like superheroes to rescue their patients. The team wasn't about second-guessing them or questioning their judgment.
We made it very clear that there was never a wrong time to call the Rapid Response Team, and that it was never a mistake to make that call. Worries, gut feelings, hunches, and instinct were just as valid reasons for nurses calling the Rapid Response Team as a change in vital signs. We reinforced that our Rapid Response Team would only be as good as the nurse on the floor.
In its first month, our Rapid Response Team received nine calls. That number has steadily increased. Today, we receive about 30 calls a month. Better still, we have significantly reduced the number of codes outside of the intensive care unit (ICU), which means saved lives.
Before rapid response, we would average between four and 10 codes per month outside the ICU on the medical/surgical floors. In the first year of Rapid Response we had an 80 percent decline in codes outside the ICU. In more than a few cases we were able — with the help of the patients and their families — to resolve end-of-life issues so that patients could have natural deaths. So far this year, we had six months with one code outside the ICU and three months with no codes.
Rapid response has paid many dividends, but one I especially appreciate is the trust that exists now among the nursing staff and the Rapid Response Team.
"Sometimes all you need is a new set of eyes," said one medical/surgical nurse. "And that's what rapid response is."
Thomas Finer, RN, BSN, CCRN, is the manager of Critical Care Services at Robert Wood Johnson University Hospital Rahway.
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