If a patient’s condition begins to deteriorate quickly, it’s often the job of the bedside nurse to call a rapid response team (RRT) for immediate assistance. The team’s primary function is to provide critical care expertise in an effort to save the patient’s life.
For bedside nurses, making these judgment calls can be difficult, not to mention overwhelming. RRTs in hospitals across the nation function differently, and according to a recent study co-authored by Jacinda Bunch, PhD, RN, at the University of Iowa School of Nursing, these differences can impact patient outcomes.
“Every hospital structures their rapid response team a little bit differently, and there’s no one way everyone has to do it,” Bunch tells Florence-Health. “When we’re looking at rapid response teams, what we’re really trying to do is intervene early.”
What did the study find?
The study, published in the Journal of the American Medical Association, looked at nine different hospitals in the Get With The Guidelines-Resuscitation program. Using data from another RRT study, called Hospital Enhancement of Resuscitation Outcomes for In-Hospital Cardiac Arrest (HEROIC), researchers found these commonalities among RRTs at top-performing hospitals:
- A staff without competing clinical responsibilities
- Dedication to serving as a resource for bedside nurses in surveillance of at-risk patients
- Collaboration with bedside nurses during and after a rapid response
- Activation by a member of the care team without fear of reprisal from physicians or hospital staff
Here’s what they found in RRTs at non-top-performing hospitals:
- A staff with competing clinical responsibilities
- Less engagement with bedside nurses
- Reports from nurses concerned about potential consequences from activating the RRT
What does this mean for healthcare professionals?
According to Bunch, top-performing hospitals had a team of providers that were solely dedicated to the rapid response team; these providers were not taking care of any other patients and thus able to invest more time in rapid response calls.
“In other hospitals, the people who make up the rapid response team may have their own patients they are responsible for,” Bunch says. “When they get that call to go help, they have to pass off their patients to someone else. So, there’s a little bit of lag time.”
Bunch, who has previous experience calling for and responding to rapid response needs, adds that a successful RRT empowers bedside nurses to ask for assistance without hesitation.
“If a nurse has had someone say ‘Well, why did you call the team for that?’ in the past, they may be less likely to call the team the next time,” Bunch explains. “They may wait longer, and the patient may deteriorate a little longer. We want nurses to feel comfortable calling and asking for help earlier.”
Co-author Kimberly Dukes, PhD, says it’s important to keep in mind that while all hospitals are focused on patient safety, some have fewer resources, staff members or structural abilities, which can affect the way they organize their RRTs. She said the study’s results need to be validated in a greater variety of institutions.
“This is just the beginning of an area that we really think is going to be beneficial for patients, as well as healthcare workers on both ends of a rapid response,” Dukes explains. “It’s going to be important to think about a variety of hospital settings and look for more variations in how they structure their RRTs and what makes them successful.”
How can clinicians help the RRT?
The researchers said dedicated RRT members should take the time to debrief with bedside nurses in order to proactively ensure the patient doesn’t deteriorate again.
“It’s important to be able to think about processes before, during and after with bedside nurses and physicians,” Dukes says. “And to make sure that overall bedside staff felt comfortable calling [the RRT].”
Bunch adds that nurses should get involved with their hospital’s RRT to understand common practices.
“Ask those questions — ‘How many rapid responses did we have?’ and ‘What did we learn from those?’ to see what’s going on in your hospital,” Bunch advises. “If you have the opportunity to get involved and improve it, then by all means.”