Flowchart for monitoring rapid response team performance

Use modified early warning score (MEWS) to prevent CPR in inpatient wards

Concept Schematic


 Figure 1. Flowchart for monitoring RRT effectiveness
(click on individual parts of map to hyperjump to relevant text section)

Schematic Legend

Orange background : failure to proceed smoothly, requiring quality improvement efforts.

Pink background QA : monitor process compliance

Red background QA : a clinical outcome indicator

Monitoring Effectiveness Why not CPR team?

Total CPR events per 1,000 discharges
CPR events outside ICU per 1,000 discharges
{8.QA}
Hospital mortality {10.QA}
Mortality rate at discharge for CPR patients
Mortality rate for ward CPR patients {8a.QA}
Number of unplanned ICU admissions {9.QA}
Staff satisfaction {7.QA}
Monitoring Process Compliance
CPR on DNR patients per 1,000 discharges {3a.QA}
RRT activations per 1,000 discharges {4.QA}
RRT activations by ward per 1,000 discharges
{4.QA}
Express handover (SBAR) compliance {6.QA}
Response time compliance {5.QA}
The average survival rate to hospital discharge for all
patients undergoing CPR was only 10~15% between
1983~1989, and has not improved measurably since. For
patients with certain diagnoses (e.g. metastic cancers),
survival rates are even lower.
Furthermore, patients who were successfully resuscitated
often undergo aggressive treatment in the intensive care
unit and suffer complications including rib fractures,
permanent neurological deficits, and impaired functional
status. Even without physical injury, CPR can lead to
psychological harm that lowers survivors' quality of life.
It has been shown that 2/3 of patients show evidence of
identifiable signs of deterioration within 6-8 hours of
arrest.
Failure to Rescue from Complication
Failure to rescue (FTR) refers to a death after a treatable
complication. The rate of FTR in surgical patients derived
 from routine administrative data is recognized as an
important indicator of patient safety (in the USA).

Definition of "Rapid Response Team/System" 

3a. DNR 

Modified Early Warning System (MEWS) 

Mobile Nursing Station 

4. Activation/Escalation Protocol 

4a. Condition H 

7. Staff Satisfaction 

Example Rapid Response Team (RRT) staff satisfaction survey

Please answer the follow questions with respect to your

encounter with the Rapid Response Team. {use 5-point Likert
scale for each question}

Person completing the survey:

Attending
Resident
Physician Assistant
Nurse
Nursing Assistant
Family
 1. The team responded promptly (within 15 minutes)
Disagree ← 1 2 3 4 5 → Agree
2. The team was respectful during their encounter with
staff on your unit
Disagree ← 1 2 3 4 5 → Agree
3. The team provided help in clinical decision making while
on the unit
Disagree ← 1 2 3 4 5 → Agree
4. The patient's outcome was affected positively by the RRT
being called
Disagree ← 1 2 3 4 5 → Agree
5. I felt comfortable activating the RRT
Disagree ← 1 2 3 4 5 → Agree
6. Overall the RRT was useful and beneficial
Disagree ← 1 2 3 4 5 → Agree
7. I would not hesitate to call the RRT again
Disagree ← 1 2 3 4 5 → Agree

Any further comments or observations about the Rapid

Response Team? {free text}

Submit

Example results of Survey [16]

Figure 7a. Staff satisfaction with RRT
Figure 7b. Staff satisfaction with RRT

Figure 7c. Staff satisfaction with RRT

 Figure 7d. Staff satisfaction with RRT

8. CPR outside the ICU 

RRT Performance Measures 

Monthly Report on RRT Items 

Data Dictionary 

Indicators 

References: 

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