Transcript MET - Healthcare Association of New York State

Rapid Response Team
RRT
What is RRT
A Team designed for early intervention for
potentially unstable patients
A Proactive approach to patient care
Who makes up the RRT
Varies Widely
• Nurses
• Respiratory Therapists
• Physicians (Attendings, Fellows & Residents)
Research Findings
Majority of patients who arrest in the hospital
have signs of deterioration for 6-8 hours
Saves Lives
Reduces LOS
Calls for RRT’s doubles after the 1st year
implementation
30 % decrease in cardiopulmonary arrests in
one documented study.
Approximately 40 % of patients survive to
discharge following RRT activation
Research Findings cont’d
Expedites DNR decisions in appropriate
cases
Often only simple interventions needed
One of 8-1600’s RRT calls found a patient
was on 3x’s glucophage, admission was
avoided with medication adjustment
Facilitates staff education
Suggested Criteria for Initiating
RRT
Evidence-based literature findings:
•
Initial call should be made to appropriate
covering physician or team prior to
initiating RRT call
• Staff member worried about the patient
• Inadequate or untimely response from
covering team
Criteria cont’d
Acute Change in:
Heart Rate <40 or > 130
SBP < 90 mm Hg
RR <8 or >30
O2Sat <90
Mental Status (LOC)
UO < 50 ml/hr
Top 5 Interventions for RRT Calls
Oxygen therapy
Non-invasive positive pressure
ventilation by mask or ventilator
Nebulizer treatments
IV fluid bolus required
Lasix administered
Potential Economic Benefit
Conservatively ICU care costs $2,000$3,000/day
If 10% of admissions avoided and 10% of
those patients admitted to ICU have
shortened LOS’ we would save 5,500 ICU
days. Results in $11,000,000 savings
Opens up additional ICU beds for patients
requiring admission.
Facilitates more timely admissions from the
Floor, ED, PACU and outside transfers
MICU RRT Experience
MICU Responders
Charge Nurse
Resident (Fellow/Attending)
Started July 2003 on 2 units, gradually
increased to 6 units (medical)
From July 2003-May 2004: 24 calls, 15
admissions (42.4% saved ICU admissions)
57.6% of patients admitted after a RRT
response had 1.4 days less ICU LOS
MICU Experience cont’d
Top 3 Primary events for calls made:
Respiratory Distress
Hypotension
Change in LOC
Time Investment:
10-60 minutes per call
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Rapid Response Team
1 Staff Education
2 RRT Model modified/Education
Dates
Calls
Admissions
Barriers
Late Calls…near arrest
Units initially hesitant to call for help
Concern about floor physician/ICU physician conflict
Floor nurses concerned about “going over someone’s
head”
Limitation of resources…using stressed resources
Documentation of event
No documentation from requesting units
Inconsistent documentation from responders
PLAN
Modify RRT Model
Responders are now ICU Charge Nurse and Respiratory
Therapy Supervisor. Attending/Resident/Fellow/NP will
respond when appropriate and requested by the RRT
Educate
RRT Presentation to Leadership and Staff
Collect Data
Ongoing collection
Analyze and track trends
Evaluate and Report
Effectiveness of RRT
Barriers
Patient outcomes