Implementation of a rapid response team in a large nonprofit Brazilian hospital: improving the quality of emergency care through Plan-Do-Study-Act

Abstract

Objective To describe the implementation of a rapid response team in a large nonprofit hospital, indicating relevant issues for other initiatives in similar contexts, particularly in Latin America. Methods In general terms, the intervention consisted of three major components: (1) a tool to detect aggravation of clinical conditions in general wards; (2) the structuring of a rapid response team to attend to all patients at risk; and (3) the monitoring of indicators regarding the intervention. This work employed four half-year Plan-Do-Study-Act cycles to test and adjust the intervention from January 2013 to December 2014. Results Between 2013 and 2014, the rapid response team attended to 2,296 patients. This study showed a nonsignificant reduction in mortality from 8.3% in cycle 1 to 5.0% in cycle 4; however, death rates remained stable in cycles 3 and 4, with frequencies of 5.2% and 5.0%, respectively. Regarding patient flow and continuum of critical care, which is a premise of the rapid response system, there was a reduction in waiting time for intensive care unit beds with a decrease from 45.9% to 19.0% in the frequency of inpatients who could not be admitted immediately after indication (p < 0.001), representing improved patient flow in the hospital. In addition, an increase in the recognition of palliative care patients from 2.8% to 10.3% was noted (p = 0.005). Conclusion Implementing a rapid response team in contexts where there are structural restrictions, such as lack of intensive care unit beds, may be very beneficial, but a strategy of adjustment is needed.

Automated documentation of vital parameters in wards using portable stations - Effect on proper triggering of the rapid response team: a study protocol of a cluster randomized clinical trial

“…( 6 ) After the introduction of RRTs in a large Brazilian nonprofit hospital, a significant reduction in waiting time for ICU beds among inpatients who could not be admitted immediately after indication was determined, as well as an increase in the recognition of palliative care patients; however, no difference in hospital mortality was detected. ( 19 ) Similar results were observed after the implementation of RRTs in a Brazilian university hospital, where a reduction was observed in in-hospital cardiac arrest but not in hospital mortality. ( 20 )…”

Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study

“…Over the past two decades, RRT has been implemented in many secondary or tertiary hospitals in the belief that early detection and timely management of at-risk patients will improve hospital outcomes [10][11][12]. Several recent studies have demonstrated this belief by showing that RRT could help reduce in-hospital mortality rates [13][14][15][16][17][18]. In addition, RRT implementation has been shown to improve the adherence to the sepsis bundle in HOS [9].…”