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Crit Care Nurse-2007-Thomas-20-7 PDF
Crit Care Nurse-2007-Thomas-20-7 PDF
the ICU, cardiopulmonary arrests, organization’s financial savings of transfers from the medical-surgical
and complications that cause longer $171480 per year was calculated by units to the ICU were decreased by
stays in the hospital. The process of using labor and cost accounting 10%. Because of early interventions,
patient care involves multiple staffing methods (see Table). 63% of all RRT patients remained in
interactions and a complicated the medical-surgical units and did
application of caregivers’ knowledge, Impressive Results After not require a change in the level of
skills, expertise, technology, supplies, 16 Months care (Figure 4). Overall, only 2% of all
and medications. Patient care is not According to data reported in RRT patients experienced a code
one single intervention or a series of 267 patients (Figure 2), use of RRTs blue event during their hospital stay.
isolated events. The RRT initiative during a 16-month period resulted Although RRT patients had a mean
helps to keep patients on track to in a 56% reduction in the monthly stay of 10 days, which implies a high
ensure that they will have a timely rate of code blues in medical-surgical clinical acuity level, the total survival
discharge. The financial impact of units (Figure 3). In 2006, the mean rate at discharge was 86%.
RRT programs on healthcare organi- number of code blues outside the The RRT steering team collects
zations will become apparent in ICU, emergency department, and data on an ongoing basis and dis-
time, but this impact must be viewed operating room per 1000 discharges tributes monthly reports within the
in light of RRTs’ immeasurable bene- each month was 0.63, a decrease organization. Data collected on loca-
fits to patients and their contribution from 1.22 in 2005. Unanticipated tion, shift, day of the week, and
to the overall decline in hospital
mortality and morbidity.
40
This RRT financial benefit model
No. of calls
30
quantifies costs savings with the 20
general assumption that improving 10
quality increases the number of 0
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1 These results show that reducing
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Data collection is ongoing for
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monthly analysis to provide feed-
back for performance improvement
Figure 3 Total number of code blue calls outside of the intensive care units and of the RRT team. Educational ses-
emergency department from May 2005 through August 2006. sions are organized for staff growth
and development.
100%
% of patients
Summary
50%
It is difficult to measure the num-
0% ber of lives that have been saved since
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the implementation of RRTs. Dr Don
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Berwick, president and chief execu-
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calls (18%) occur on Wednesdays protocol (63%), Figure 5 Most common reasons that nurses in medical-surgical
units called the rapid response team to a patient’s bedside.
than on other days, but the calls electrocardiog-
were fairly evenly distributed across raphy (29%), Nebulizer
the week. The mean duration of an arterial blood Chest radiography
Furosemide
RRT consultation at the bedside was gas analysis
30 minutes; consultations lasted (23%), checking Electrocardiogram Arterial blood
from a maximum of 1 hour 57 min- of blood sugar gas analysis
utes to a minimum of 9 minutes. level (16%), chest
Blood
Many times, staff reported more radiography glucose check
than 1 reason for activating an RRT: (21%), adminis-
a staff member was concerned about tration of
the patient (50%) or the patient had furosemide Oxygen protocol
a change in respiratory status (45%), (8%), treatments Figure 6 Interventions used by rapid response team during
mental status (24%), heart rate or with a respira- bedside call (mean percentages): May 2005 through August
rhythm (14%), or blood pressure (12%; tory nebulizer 2006.
References
1. Rogers A, Wei-Ting Hwang S, Aiken L, medical emergency team on reduction of 14. Ashcraft A, DiAgnostino A. Differentiating
Dinges DF. The working hours of hospital incidence of and mortality from unexpected between pre-arrest and failure-to-rescue.
staff nurses and patient safety. Health Aff cardiac arrests in hospital: preliminary Medsurg Nurs. 2004;13:211-216.
(Millwood). 2004;23:202-212. study. Br Med J. 2002;324:387-390. 15. Simmonds T. Best practice protocols:
2. Clarke S, Aiken L. Failure to rescue. Am J 9. Bellomo R, Goldsmith D, Uchino S, et al. implementing a rapid response system of
Nurs. 2003;103:42-47. Prospective controlled trial of effect of med- care. Nurs Manage. 2005;36:41-59.
3. Aiken L, Clarke S, Sloane DM, Sochalski J, ical emergency team on postoperative mor- 16. Ward WJ. The Business Case for Implementing
Silber JH. Hospital staffing and patient mor- bidity and mortality rates. Crit Care Med. Rapid Response Teams [PowerPoint presen-
tality, nurse burnout, and job dissatisfac- 2004;32:916-921. tation]. Available at: www.ihi.org/IHI/Topics
tion. JAMA. 2002;288:1987-1993. 10. Lee A, Bishop G, Hillman KM, Daffurn K. /CriticalCare/IntensiveCare/Tools/Business
4. Sochalski J, Aiken L. Accounting for variation The medical emergency team. Anaesth CaseforImplementingRRTsPresentation
in hospital outcomes: a cross-national study. Intensive Care. 1995;23:183-186. .htm. Accessed November 2, 2006.
Health Aff (Millwood). 1999;18:256-259. 11. Edson BS, Williams MC. 100,000 lives cam- 17. 100K lives campaign. Available at: www.ihi
5. Needleman J, Buerhaus P, Mattke S, Stewart paign and the application to children. J Spec .org/IHI/Programs/Campaign/Campaign
M, Zelevinsky K. Nurse staffing levels and Pediatr Nurs. 2006;11:138-142. .htm?TabId=1. Accessed November 2, 2006.
the quality of care in hospitals. N Engl J 12. Brindley PG, Markland DM, Mayers I, Kut-
Med. 2002;346:1715-1722. sogiannis DJ. Predictors of survival follow-
6. Gosfield A, Reinertsen J. The 100,000 lives ing in-hospital adult cardiopulmonary
campaign: crystallizing standards of care resuscitation. Can Med Assoc J.
for hospitals. Health Aff (Millwood). 2002;167:343-348.
2005;24:1560-1570. 13. Peberdy MA, Kaye W, Ornato J, et al. Car-
7. Institute for Healthcare Improvement. diopulmonary resuscitation of adults in the
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/campaign. Accessed November 1, 2006. from the National Registry of Cardiopul-
8. Buist MD, Moore GE, Bernard SA, Waxman monary Resuscitation. Resuscitation.
BP, Anderson JN, Nguyen TV. Effects of a 2003;58:297-308.
1. What group encouraged American hospitals to implement 7. Which communication technique was used at the Delnor
rapid response teams (RRTs)? Community Hospital in their implementation of RRTs?
a. The Institute for Healthcare Improvement a. BCLS
b. American Heart Association b. ACLS
c. American Hospital Association c. SBAR
d. Institute for Continuing Care d. SOAP
2. Why was the use of RRTs recommended? 8. What was the criteria for determining when the RRT should be
a. To improve patient outcome called known as?
b. To reduce hospital costs a. Initiation criteria
c. To prolong hospitalization b. Activation criteria
d. To reduce the risk of malpractice c. Problem criteria
d. Situational criteria
3. What is the goal of a RRT?
a. To provide rapid response to emergency room patients 9. What was the primary role of the RRT at Delnor Community
b. To provide rapid response to intensive care unit patients Hospital?
c. To prevent deaths outside of the intensive care unit a. Collaborate with the nurse at the patient’s bedside to determine if fur-
d. To prevent deaths in an emergency department ther interventions were needed
b. Review the chart for the previous 24 hours to determine what was
4. How does RRT foster collaboration? overlooked
a. Through chart review and recommendations c. Call the primary physician to report symptoms
b. Through assessment and immediate intervention d. Transfer the patient to the intensive care unit
c. Through medications and pharmacy consult
d. Through dietary and physical therapy consult 10. In the f irst 16 months after implementation of
Delnor Community Hospital’s RRT, the medical-surgical
5. How long before an unexpected critical event or actual unit code blues were reduced by what percentage?
cardiac arrest does a patient’s baseline begin to deteriorate? a. 56%
a. Mean of 30 minutes b. 68%
b. Mean of 2.5 hours c. 74%
c. Mean of 4.5 hours d. 86%
d. Mean of 6.5 hours
11. What was the challenge identif ied by intensive care unit nurses
6. What percentage of postoperative complications requiring trans- in acceptance of RRT roles?
fer to the intensive care unit can reportedly be reduced by RRTs? a. Communication with physicians
a. 30% b. Staffing cost
b. 42% c. Abandoning their own patients
c. 58% d. Daily collaboration with medical surgical nurses
d. 67%
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