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What is RRT? • A method of bringing ICU-level care to the bedside of clinically deteriorating and critical patients by a multidisciplinary team • When a nurse is concerned about the patient’s worsening condition, RRT responds to the patient at the bedside • The RRT will stabilize the patient’s condition and integrate his/her care with the primary team Why RRTs? • To prevent deaths outside the ICU by attending to the patient as soon as the primary care team recognizes the need for the RRT to intervene • “Help is available around the clock” • Primary physicians are busy and may not be available • Not all staff have enough experience to deal with critically ill patients Evidence-Based Practice Studies show that RRTs results in: • 50% reduction in the occurrence of cardiac arrest outside the ICU • 58% reduction in post-operative complications requiring transfer to ICU • 37% reduction in post operative deaths. • RRTs may decrease the overall hospital mortality by a mean of 26%. How Does it Work ? • Primary nurse recognizes a change in the baseline patient’s condition • Physiologic changes can be gradual or sudden, they should trigger calling the RRT Triggers for Calling the RRT (Bellomo et al) Staff Concerned/Worried "THE PATIENT DOES NOT LOOK?ACT RIGHT", gut instinct that the patient’s condition is deteriorating Change in Respiratory Rate / Labored Breathing Respiratory rate is less than 8 or greater than 30 per minute Change in Oxygenation Oxygen saturation below 90% Change in Heart Rate Heart rate changes to less than 40 bpm or greater than 120 bpm Triggers for Calling the RRT Change in Blood pressure Systolic pressure drops below 90 or rises above 180 mmHg Hemorrhage The patient develops uncontrollable bleeding from any site Decrease in Urine Output Urine output is less than 50 cc over 4 hours Triggers for Calling the RRT Decreased Level of Consciousness The patient becomes somnolent, difficult to arouse, confused, or obtunded Other Alterations in Consciousness Changes in mental or CNS status, slurred speech, limb or facial weakness, seizure, etc. Additional Criteria Chest pain unrelieved by nitroglycerin, threatened airway, or uncontrolled pain Organization of RRTs • Patient’s baseline condition deteriorates during 6.5 hours before an expected critical event or actual cardiac arrest happens • RRT constitutes of a group of trained healthcare professionals (intensivists, nurses, respiratory therapists…) Organization of RRTs (Pronovost & Angus) Rapid Response System Models Model Personnel Medical Emergency Team Physicians (intensivists or hospitalist) and nurses Critical Care Outreach Critical Care physicians and nurses Rapid Response Team Critical Care nurse, respiratory therapist, and physician (critical care or hospitalist) ü Pilot test in 2004 ü 128-bed non-teaching acute care community hospital ü Team members included: 6 nursing leaders, 4 ICU staff nurses, 3 respiratory therapists, and the chief nursing officer. A Hospital’s Experience with RRT (William S. K.) Planning ü Review current evidence-based practice ü Establish an RRT structure ü Evaluate the skill level of the members ü Establish triggers for calling the RRT ü Provide education ü Measure results ü Deploy program pagers ü Develop feedback mechanisms ü Provide ongoing education for responders A Hospital’s Experience with RRT Implementation ü RRT team: Critical care nurse and respiratory therapist ü In-house call 24/7 ü Easy-to-remember pager 1111 ü RRT expected to arrive at the scene within 3-5 minutes ü Uniform communication technique: SBAR A Hospital’s Experience with RRT Follow-up ü Key indicators were tracked to measure patient’s outcomes before and after implementation of the RRT ü Information collection included: demographics, location, reasons for the call, call start time, call end time, and narrative information for the primary physicians A Hospital’s Experience with RRT Costs of RRT • Special remunerations of the RRT members • Costs of staff education Benefits of RRT Significant improvements in clinical outcomes: A focused study compared 24,193 patients hospitalized before the