RAPID RESPONSE TEAMS: A TEMPLATE FOR DEVELOPMENT

1. RAPID RESPONSE TEAMS:A TEMPLATE FOR DEVELOPMENT Robert E. Brush Jr., M.D. Borgess Medical Center

2. Rapid Response Team • “A Rapid Response Team (RRT, MET) is a group of healthcare professionals who respond quickly to threatened clinical deterioration.” • No coincidence that it is #1 in the “Six Advances that Save Lives” of the 100K Lives Campaign of IHI.

3. RRT: Planning Phase • Who’s in charge; who owns it? • Who will do the work of spreading it? • Physician, nurse, respiratory therapist? • Considerations: Someone with passion for the project, clinical credibility and the time necessary for implementation

4. RRT: Planning Phase(continued) • Develop a “build the case” in-service/talk that can be used initially with leadership. • No more than 15 minute powerpoint with key features; i.e., rationale, brief history, outcomes that have been achieved and the business case. One good reference to use; e.g., Bellomo.

5. RRT: Planning Phase(continued) Obtain Baseline Data for Your Facility: • Monthly code rate per 1000 discharges • Monthly percent of codes outside the ICU • Actual percent monthly mortality • (number of unplanned returns to ICU/mo)

6. RRT: Planning Phase(continued) Team Composition Considerations: • Physician/resident availability • Critical care nurses • Nurse practitioner/Physician assistants • Respiratory Therapists • Others: PharmD, etc.

7. RRT: Planning Phase(continued) • Team notification – beeper vs. overhead page and beeper; room # on beeper. Work with communications department, operators. • Team equipment – What’s available on the floor; consider bringing equipment, drugs.

8. RRT: Planning Phase(continued) Engage Leadership • Who needs to be on board up front? CEO, CMO, Med Exec Committee, CNO, RT Department head, Quality Department, Board of Trustees? • Do the 15-30 minute presentation, making the case.

9. RRT: Implementation • Training the team – may need little training, depending on makeup and experience. • Considerations include: • Review criteria for calling RRT. • Review a list of “typical” interventions. • Review the syllabus from Fundamentals of Critical Care from ASCCM.

10. Pick a Pilot Unit: RRT: Implementation (continued) • Considerations include: • How many codes/month? • General med/surg vs. cardiology, etc. • How familiar is the spread team with the unit? • What’s the “culture” of the unit regarding change?

11. RRT: Implementation (continued) Informational Packet to be Distributed to Nursing Prior to Meeting: • Brief introduction including rationale • “When to call” criteria spelled out/expectations • How to document • Quiz:

12. RRT: Implementation (continued) Engage Pilot Unit Management, MD’s • Pilot unit nurse managers, charge nurses, etc., need to review packet and understand concept before in-servicing nurses. • Ask local leaders to identify “early adopters” and “early naysayers.” • Do brief presentation to high volume MD’s if possible, otherwise – a letter of explanation.

13. RRT: Implementation (continued) In-service for Pilot Unit Nursing/RT Staff • Can be at regularly scheduled staff meetings • Review packet • Give local examples of “failure to rescue” stories, if available • Can also do as informal “walk around” to catch the key players

14. RRT: Implementation (continued) Communication Plan • Communicate housewide as pilot unit goes live. • Communication methods vary locally with what proves most effective; i.e., hospital newsletter, posters, email, etc.

15. RRT: Maintenance • RRT “tracker” – excel spread sheet to track things such as reason for call, time spent, disposition of patient, etc. • Monthly metrics • Code rate • Codes outside critical care • RRT calls/month • Mortality rate, etc.

16. RRT: Maintenance (continued) Follow up/“Continual Tending” • Return to pilot unit with “stories,” kudos, etc. • Meet with RRT team members for input, particularly perceived barriers. • Tell stories to MD’s whenever possible. • Decide on Spread method – depends on local factors.

17. RRT: Maintenance (continued) Barriers/Problems • Clarification to nursing of “when to call” • Intimidation of nursing staff by RRT team • Physician push-back • Inappropriate calls

18. RRT: Maintenance (continued) Ongoing, Redundant COMMUNICATION, for example: • Video or powerpoint for orientation • “Storyboard” for skills fair • Video for ACLS recertification • Newspaper articles

19. Rapid Response Teams Contact Information • Borgess Medical Center Project Manager Robert Brush, MD Chief Quality Officer Borgess Medical Center – Kalamazoo, MI rbrush@borgess.com • System Office Liaison John Garbo Director, Clinical Excellence jgarbo@ascensionhealth.org 314-733-8193