Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators

Abstract

Objective The objective of this study was to qualitatively describe the impact of a Rapid Response Team (RRT) at a 944-bed, university-affiliated hospital. Methods We analysed 49 open-ended interviews with administrators, primary team attending physicians, trainees, RRT attending hospitalists, staff nurses, nurses and respiratory technicians. Results Themes elicited were categorised into the domains of (1) morale and teamwork, (2) education, (3) workload, (4) patient care, and (5) hospital administration. Positive implications beyond improved care for acutely ill patients were: increased morale and empowerment among nurses, real-time redistribution of workload for nurses (reducing neglect of non-acutely ill patients during emergencies), and immediate access to expert help. Negative implications were: increased tensions between nurses and physician teams, a burden on hospitalist RRT members, and reduced autonomy for trainees. Conclusions The RRT provides advantages that extend well beyond a reduction in rates of transfers to intensive care units or codes but are balanced by certain disadvantages. The potential impact from these multiple sources should be evaluated to understand the utility of any RRT programme.

“Deterioration to Door Time”: An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients

“…17 We postulate that there are likely systemrelated and patient-related factors that influence this relationship and contribute to what has come to be known as Bfailure to rescue.^1 8,19 System-related factors may include general inpatient floor staffing models and provider-patient ratios, 20 temporal issues including the time of day and day of the week at which deterioration occurs, 21 adherence to vital sign monitoring protocols, 22 and ICU bed availability. 7,23,24 There are also cultural barriers preventing staff from calling for assistance, [25][26][27][28] and nurse/physician providers often do not accurately self-assess the quality of their care for clinically deteriorating patients. 28 Patient factors, such as severity of illness, age, 29 medical comorbidities, and the number and type of specific criteria heralding deterioration 12,13,30 may all play a role as well.…”

Outcomes of cardiopulmonary resuscitation in the emergency department

“…CPR was performed in accordance to the most recent guidelines. In each CPR performed, there was a rapid response team present (11,12). This team consisted of a physician, senior resident or intensivist or hospitalist, physician's assistant, critical care specialist, clinical nurse specialist and respiratory therapist.…”

Potential Structural Obstacles to Effective Implementation of Neonatal Intensive Care Unit Rapid Response Teams

“…All efforts should be made to decrease structural obstacles that hinder prompt response. Units on different floors require responders to either rush up or down stairs (increasing the risk for injury), or wait for an elevator (increasing delays) [14]. A study by Terrin et al noted the potential for significant reductions in preterm neonate morbidity in facilities where the delivery room and NICU were directly connected as opposed to being on separate floors [15].…”