Rapid Response Teams: Policy Implications and Recommendations for Future Research

Quels sont le fonctionnement, les caractéristiques, les effets et les modalités d’implantation des équipes d’intervention rapide ? Une revue de la littérature

Introduction : Hospitalized patients are at risk of unrecognized clinical deterioration that may lead to adverse events.Context : Rapid Response Teams (RRTs) exist around the world as a strategy to improve patient safety.Objective : To explore how RRTs work, their characteristics, impacts, and methods of implementation.Design : Literature review.Method : Consultation of the databases CINAHL, MEDLINE, PUBMED, COCHRANE library, SCOPUS, and PROQUEST Dissertations and Theses. Keywords : “health care team” and “rapid response team”.Results : 121 articles were included. The collected data were divided into five categories : 1) composition and operation of RRTs, 2) benefits and limitations of RRTs, 3) perceptions of RRTs by health care teams, organizations, and patients, 4) implementation strategies, and 5) facilitators and barriers to implementation.Discussion : Although there are many articles related to RRTs, it appears that : 1) few studies analyze the difference in outcomes in hospitalized patients related to the composition of RRTs, 2) few studies describe how RRTs should work, 3) more studies are needed on the impacts of RRTs on hospitalized patients, 4) organizations’ and patients’ perceptions of RRTs are not well studied, and 5) more studies are needed on the best way to implement an RRT.Conclusion : The results show that there is a lack of studies on the difference in outcomes in hospitalized patients related to the composition of RRTs, on how RRTs should work, on the impacts of RRTs on hospitalized patients, on organizations’ and patients’ perceptions of RRTs, and on the factors that influence the success or failure of the implementation of an RRT.

Perceived Barriers to Rapid Response Team Activation Among Nurses

The purpose of this literature review was to investigate the major barriers nurses face when it is necessary to seek additional assistance and resources by calling the rapid response team (RRT) in order to manage and stabilize a clinically deteriorating patient. A total of 40 articles were reviewed. Eight barriers were identified as having an impact on RRT activation, either causing a delay in activation time or preventing activation altogether: a lack of consistent RRT education among nurses, the established hierarchy in the hospital, an uncertainty about when to call the RRT if clinical deterioration is subtle or gradual rather than abrupt, a perceived need to justify a decision to call the RRT, the increased workload for both the ICU nurse and the medical-surgical nurse, negative past experiences with RRTs, an unsupportive unit culture, and less nursing experience. Suggestions for overcoming these barriers include RRT education for nurses and physicians in addition to fostering a supportive unit culture.

A measure of facilitators and barriers to rapid response team activation

PURPOSE

Poor patient outcomes and increased costs may be associated with underutilization of RRTs. The aim of this study was to develop and test an instrument that identifies specific facilitators and barriers to rapid response team (RRT) activation.

METHODS

Using an exploratory design, we surveyed a convenience sample of 250 registered nurses (RNs) employed in five Illinois hospitals. Participants completed the online RRT Facilitators and Barriers Survey (RRT-FBS), a 36 item survey developed by the researchers. The survey contains two sections, facilitators and barriers. Items in the facilitators subscales described nursing unit culture, RRT knowledge, and RRT member characteristics. Items in the barriers subscales described nursing unit culture, RRT education, and RRT member characteristics. Item analyses were conducted through exploratory factor analyses; internal consistency estimates were obtained. Descriptive statistics were conducted on the demographic data to describe sample and setting characteristics.

RESULTS

The final sample consisted of 202 nurses from four hospitals. We conducted an item analysis and were able to reduce the survey to 30 items with a secondary analysis. The full scale alpha was 0.752. Cronbach's alphas for subscales ranged from 0.770-0.897.

CONCLUSIONS

Facilitators and barriers may vary across institutions. This scale shows promise for identifying facilitators and barriers to nurses' use of rapid response teams and may provide a foundation for interventional studies promoting RRT utilization. In addition, more frequent education, emphasizing the RRT process, may be an effective method to maintain high rates of RRT activation and increase confidence.

Nursing students' clinical judgment regarding rapid response: the influence of a clinical simulation education intervention

AIM

The aim of this study was to examine the impact of a novel educational intervention on student nurses' clinical judgment regarding the management of patients experiencing rapid clinical deterioration.

METHOD

A randomized sample of baccalaureate nursing students enrolled in the final semester of their program at a midwestern public university participated. All students (N = 79) were pretested; the control group (n = 39) was posttested after receiving traditional code blue and rapid response education. The intervention group (n = 40) was posttested after receiving a novel education intervention.

RESULTS

An independent t-test revealed that nursing students who received the innovative education intervention had significantly higher posttest scores (M = 90.91, standard deviation [SD] = 8.73) than did the nursing students who had not received the intervention (M = 64.80, SD = 19.69), t(77) = 7.65, p <.001).

CONCLUSIONS

The findings demonstrate that clinical simulation is effective in improving students' knowledge and clinical judgment, specifically concerning rapid response systems.

Rapid response teams and failure to rescue: one community's experience

The rapid response team has been proposed as an effective strategy for reducing failure-to-rescue rates among adult inpatients; however, there is little research evidence to support the recommendation. This exploratory study used survey and administrative data to describe rapid response team characteristics and penetration among hospitals in a large metropolitan area while tracking corresponding failure-to-rescue rates among surgical inpatients over 5 years. The findings are promising and invite further investigation.

Clinical nurse specialists as leaders in rapid response

The purposes of this article were to provide background information about rapid response teams (RRTs), to describe the actual and potential outcomes of RRTs, to define the potential role of the clinical nurse specialist in leading RRTs, and to provide recommendations for implementation of RRTs. Rapid response teams provide the opportunity for early intervention for patients demonstrating clinical decline before they reach a point of no return. The long-standing practice of waiting for intensive intervention (code blue) until the patient experiences cardiopulmonary arrest has shown poor outcomes, bringing this practice into question. Although research results are mixed, there is evidence to suggest that the successful use of RRTs results in clinically significant patient outcomes as evidenced by decreased cardiopulmonary arrests and decreased rates in mortality. Other positive patient, nursing, and organizational outcomes can result from RRTs and are discussed. Clinical nurse specialists are uniquely qualified to provide leadership in the development and implementation of RRTs and the monitoring of outcomes. As RRTs become a more common standard practice, further research is needed to examine their benefits and to further refine effective early intervention for high-risk patients.