Bridging gaps in rapid response systems

Abstract

lthough death is a part of everyday life for healthcare providers, avoidable death of hospitalized patients shouldn’t be. To reduce unnecessary mortality each year, hospital leaders across the nation focus on achieving the Institute for Healthcare Improvement’s (IHI) “Triple Aim.” This initiative aims to improve the patient care experience, including quality and satisfaction, and population health while reducing healthcare’s per capita cost.1-4 Rescuing a deteriorating patient before he or she progresses to a respiratory or cardiac arrest aligns with this focus. Failure to rescue a deteriorating patient in a hospital setting is now a nursing-sensitive measure reviewed by the Centers for Medicare and Medicaid Services.5 Studies show that early recognition of deterioration signs and implementation of prompt intervention can reduce permanent disability in stroke events and mortality associated with respiratory and cardiac arrests in hospitalized patients residing outside of the ICU.2,3,6,7 Historical background In 2004, the IHI recommended the implementation of rapid response teams (RRTs) to minimize unnecessary disabilities and deaths.6 As a result of this initiative, over 1,400 American hospitals implemented RRT programs by 2005.7 Before the June 2005 International Conference on Medical Emergency Teams, RRTs were commonly known as medical emergency teams or critical care outreach.8 Rapid response systems are designed to initiate RRT activation for stat assessment and treatment of patients whose clinical condition is deteriorating.8 In 2008, RRTs became a patient safety goal and a required component of hospital accreditation by The Joint Commission.7 Today, the Institute for Clinical Systems Improvement (ICSI) has created a healthcare protocol for RRTs to ensure quality. The protocol, based on evidence-based research, outlines key clinical strategies and recommendations for effective RRT implementation. According to the ICSI, eight areas need to be considered when implementing an RRT.3 (See Table 1.) Bridging gaps in rapid response systems