Indirect Effects of Rapid Response Teams - The Impact of Resident Participation
Robert P. Ferguson, MD, FACP1, Noah Hoskins, MD,1 Sreenath Vellanki2, Donna Astiz3, MD, Susan Sloan4 (1Union
Memorial Hospital, 2University of Maryland School of Medicine, 3Morristown Memorial Hospital, 4Easton Hospital)
click here to download as a PDF: RRT study
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Introduction:
- In an attempt to improve patient safety in 2004, the Institute for Health Care Improvement (IHI) encouraged hospitals to establish Rapid Response Teams (RRT's).
- RRT's were specifically designed to identify rapidly decompensating patients in order to avoid cardiopulmonary arrest and/or ICU admission.
- Some studies suggest that Rapid Response Teams have become an effective tool in reducing hospital mortality rate and code incidents, however, other indirect effects have yet to be measured.
- Specifically, there has been some concern that these teams may negatively impact the educational experience of medicine residents by circumventing the resident's opportunity to assess acutely ill patients.
- We decided to survey Internal Medicine APDIM program directors who have agreed to be members of the Community Hospital Education and Research Network, also known as CHERN, which was started in November 2007.
- CHERN is comprised of a total of 87 members:
- Community
- Municipal
- Subspecialty clinic
- This study is unique in that it surveys a new medical group.
Objectives:
- Collect demographic and other data on RRT's.
- Determine the indirect effects of RRT's on resident education.
- Evaluate communication between RRT's and the primary care teams.
- Determine the effect of RRT's on nursing morale and nursing education.
- Assess the importance of RRT's from a program director's perspective.
- Evaluate the efficacy and ease of Survey Monkey in conducting research studies at community hospitals.
Methods:
- A survey invitation, via Survey Monkey, was sent to all 87 members of CHERN up to two times in July and August 2008.
- The survey was composed of 15 questions and took less than 10 minutes to complete.
- Thirty-two members, (36%), completed the survey.
Results:
Demographic Data
Impact on Nursing Education & Morale
Impact on Resident Education
Conclusions:
- The composition of Rapid Response teams of those sampled are very similar, and is primarily composed of nurses and respiratory therapists.
- Just over half of the teams also include medical residents.
- Seventy-five percent of hospitals have had RRT's in place for 2 or more years.
- Rapid Response teams are available 24 hours a day, 7 days a week.
- Majority of hospitals receive more than 10 calls a month, with most receiving greater than 20 each month.
- Most directors feel that there are only few (<25%) inappropriately triggered calls.
- Communication between the RRT nurses and other members of care team, including residents, is adequate.
- However, adequate communication with residents is improved when residents are included on the RRT's.
- Nursing morale and education:
- Whether, or not, RRT's have improved nursing morale is still unclear, but most directors feel that this is an important issue.
- Overall, participation on RRT's has had a positive effect on resident education.
- However, this impression is more related to whether, or not there is a resident on the team.
- A large majority of programs with residents on the RRT's feel that the experience is valuable, while an equal percentage of programs that do not include residents agree that RRT's have not had a positive effect on resident education.
