Campaign Home Page Mentor Registry Home
Rapid Response Teams	Pressure Ulcers
Acute Myocardial Infarction	High-Alert Medications
Medication Reconciliation (ADE)	Congestive Heart Failure
Central Line Infections	MRSA
Surgical Site Infections	Surgical Complications
Ventilator-Associated Pneumonia	Boards on Board

Use this table to quickly find a mentor for deploying Rapid Response Teams with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.

Advocate Good Shepherd Hospital – Barrington, IL
Availability Status: Available to answer requests
Licensed Beds: 181
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Linda Lau, RN, MSN, Manager MSICU & RRT
Mentor Contact Email: Linda.Lau@advocatehealth.com
Mentor Contact Phone: 847-842-4896

Additional Information:

Advocate Good Shepherd is a community hospital in Barrington, Illinois. Our Rapid Response Team contains dedicated critical care nurses that work collaboratively with other team members to provide a strong clinical force and care delivery system.  Full time equivalent (FTE) positions are designated to assure availability for a true rapid response.   All of the Rapid Response Team RNs are required to have a minimum of two years of ICU experience, Advanced Cardiac Life Support, Pediatric Advanced Life Support and Trauma certifications and the American Stroke Association NIHSS training.  It has been said by one of the RRT RN’s that, “We can bring ICU care anywhere.” The result is critical care for all patients in need and mentoring to nurses who are at the bedside.

We felt it was vital to the success of our Rapid Response Team program to have RNs who do not have other duties such as being an ICU charge nurse or having a patient assignment.  The challenge came in making this program budget neutral.  The new Rapid Response Team RN role was created by combining a remote telemetry RN position with the rapid response role. We made the conscious decision that the new role would be staffed by existing ICU trained staff members with no new employee hired into the position.  These decisions helped to maintain the roles budget neutral status along with providing positive patient outcomes.  The combination of the roles of RRT RN and the existing dysrhythmia role allows the Rapid Response Team RN to be proactive in response to abnormal cardiac rhythms identified in centrally monitored patients while being available for Rapid Response calls.  The remotely monitored patients are continually observed by trained monitor technicians and Rapid Response Team RNs.   Along with observing the cardiac and oxygen saturation status, the RN “rounds” on each patient at least once every shift to establish a base line assessment.

The primary Rapid Response Team responders include the Rapid Response Team RN, a Respiratory Therapist, the assigned bedside RN, and the primary physician (who is just a telephone call away).  The primary team provides rapid assessment and interventions initiated per protocol.  As needed, we can expand team members to include secondary responders, which include pharmacy, laboratory, and supervisors.  If more than one rapid response occurs simultaneously, the ICU charge nurse is utilized as a back-up. The patient’s nurse and the Rapid Response Team use SBAR as a communication tool to facilitate interactions among the team and with physicians. The documentation and legal implications have been explored to meet the needs of all areas including outpatient and visitors.

Specific policies and protocols allow the Rapid Response RN to perform basic interventions without additional orders, including obtaining EKGs, ABGs, chest x-rays, laboratory diagnostics, and administering emergency medications. Obtaining these results, interventions and re-assessments, allow a higher level of communication regarding patient status to be provided to the physician.  The availability of the Rapid Response Team prevents “disengagement” of patients requiring transfer to a critical care unit, including stat radiology studies, since all patients are accompanied by a critical care RN.  The Rapid Response RN is also an integral part of the Code Blue team.

Since the implementation of the Rapid Response Team, we have expanded the program to include inpatient, outpatient, visitors and families.  Units such as OB, Mother/Baby, Pediatrics, and Behavioral Health required additional education for the Rapid Response Nurses.  Our next steps for 2007-2008 include expanding the availability to have family members activate the RRT, expanding the team as “helping hands” for in hospital pediatric monitoring and emergencies and becoming part of the Stroke Alert team.

Data collected from January 1 through December 31, 2006:

394 Rapid Response calls were documented for 2006
61.4 % were stabilized and not transferred to a higher level of care.
20.60 % (13) of the Code Blues were located out of the ICU settings as compared to 53.06% (26) in 2005.  This demonstrates a 32.46% reduction of codes outside the ICUs.
In 2006, there were 1,260 Rapid Response interventions (as described above) implemented by the Rapid Response nurses from the RRT protocols.
There were 205 documented Nurse to Nurse consults initiated
2,275 patients were remotely monitored/ admitted by the Central Tele/Rapid Response Team
99.5 % of nurses surveyed stated that the Rapid Response Team met the patient and the nurses' immediate needs.  Of physicians surveyed, 100% agree that the Rapid Response Team communicated effectively the assessment and recommendations for the patient and that the patients’ needs were met by the team.

[9/7/07]

*                *                  *

Alexian Brothers Medical Center – Elk Grove Village, IL
Availability Status: Available to answer requests
Licensed Beds: 387
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2004
Mentor Contact Name: Patty Gessner
Mentor Contact Email: gessnerp@alexian.net
Mentor Contact Phone: 847-437-5500 ext 5073

Additional Information:

Our program was quickly embraced by the entire hospital.  Nursing reports less frustration and more confidence with regards to the care of their patients.  Physicians have reported their satisfaction and believe that their patients are now in a safer environment.  The responders enjoy the opportunity to educate while on the call.

Avoided 24 code blues in 14 months.
Survival of code blue to home or rehab has increased.
Our codes per 1,000 discharges is currently 3.15.
47% of the calls are stabilized, avoiding a critical care admission and complications.
Calls have led to root cause analysis and system improvements.
[2/14/06]

*                *                  *

Allen Memorial Hospital – Waterloo, IA
Availability Status: Available to answer requests
Licensed Beds: 234
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: September 2004
Mentor Contact Name: Teresa Gavin
Mentor Contact Email: gavintm@ihs.org
Mentor Contact Phone: 319-235-3572

Additional Information:

Our Rapid Response Team is called the Medical Emergency Team.  It is composed of a nurse from either the ICU or the ED and a respiratory therapist.
When we started our MET, the ICU had a significant staffing shortage and ED visits were up.  It was decided that the ED nurses would taking the calls.  After a few months, ED and ICU nurses starting sharing the calls.  Now the ICU staff is responsible for one half of the month and the ED is responsible for the other half.  Sharing the responsibility is a benefit.  If one of the units is extremely busy, they call the other unit and ask them to respond to the MET call.  The nurses who respond to MET calls still have a patient care assignment.  We did not add FTE's. 
Initially MET staff was concerned about the time commitment.  The ICU staff now sees that the MET has helped to avoid unessecary admissions to the ICU.  We have also discussed the time savings of avoiding a code. 
Our calls are gradually increasing.  We now have some physicians who ask the staff to call the MET to evaluate a patient and call them back.  The staff has been appreciative, especially those on the evening and night shifts. 
We have found that constantly talking about the MET at department meetings has been helpful.  We also have included articles in our nursing newsletter.  The Critical Care Clinical Nurse Specialist receives all of the MET and Code Blue pages.  It has enabled us to keep better informed of the calls. 
We are currently starting to follow up on codes outside of the ICU to find out if staff should have called the MET.

• In 2006, we have been averaging 10 calls per month. 
• Calls per 1000 discharges rose from 5.13 in 2005 to 9.8 Second Quarter of 2006. 
• Percentage of codes outside of the ICU has decreased from 48.5% in 2005 to 39% Second Quarter of 2006.
• Number of total codes per 1000 discharges has decreased from 7.42 in 2005 to 3.62 Second Quarter of 2006
[8/31/06]

*                *                  *

Ball Memorial Hospital – Muncie, IN
Availability Status: Available to answer requests
Licensed Beds: 350
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: June 2006
Mentor Contact Name: Claire Lee, Director of Quality Management
Mentor Contact Email: clee@chsmail.org
Mentor Contact Phone: 765-747-4284
 

Additional Information:

The ICU Collaborative Team was charged with responsibility by leadership to estblish a Rapid Response Team shortly after returning from the 100,000 Lives Campaign kickoff meeting.  The team was formed, comprised of an ICU RN and a respiratory therapist, protocols written, staff trained, all units and medical departments informed and activated 6/1/06.  It was met with huge sucessess and continues to be very well received by staff and physicians alike.

• Avoided 201 codes in 12 months
• 58% of the calls are stabilized thus avoiding a critical care admission
• 34% of the calls are stabilized by use of nursing protocols only
• Codes were reduced from 5 per 1000 discharges to 3 per 1000 discharges in the first 18 months
[2/8/08]

*                *                  *

Benedictine Hospital – Kingston, NY
Availability Status: Available to answer requests
Licensed Beds: 222
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: April 2005
Mentor Contact Name: Petra Klein, RN, MA
Mentor Contact Email: pklein@benedictine.org
Mentor Contact Phone: 845-334-3177

Additional Information:

• With the support of hospital administration, the medical staff leadership championed the RRT model and its implementation.
• The RRT team members include a physician assistant, an ICU registered nurse, a respiratory therapist and the patient’s primary care nurse.
• Criteria and method for calling an RRT was developed.  It was emphasized to the nursing staff that an RRT could be called on the basis of staff concern alone. The first check off box on the form is “Staff Worry/Concern” with a line for text. We have taken the stance that there is no inappropriate call and that all RRTs provide learning experiences.
• Data collected from the RRT form is entered into a database for trending.  The medical staff have been overwhelmingly positive in their comments regarding the RRT initiative.
• In utilizing a multidisciplinary approach, we can take the best knowledge and skills of the various disciplines, and combine them to provide an expertise, that otherwise would be missing, and make a positive difference in patients outcomes.
• Although the primary goal of the RRT is to improve patients’ outcomes, the RRT has provided a learning opportunity for each member of the team, and has improved the critical thinking skills and knowledge of these staff.  Every RRT call has value.

• 135 calls since implementation in late April of 2005.
• 59% of the RRT calls were treated in their rooms, 41% were transferred to a higher level of care.
• 18% reduction in total inpatient codes/1000 discharges compared to the same period for the previous year.
• 75% decline in the number of unexpected deaths since RRT implementation.
• Interdisciplinary communication and enhanced collaboration has been fostered by the RRT.
• Greater sense of security among nursing staff on units outside the ICU.
• The implementation of the RRT has shown itself to be an incredible mechanism for enhancing patient safety in our facility.
[4/27/06]

*                *                  *

Berkshire Medical Center – Pittsfield, MA
Availability Status: Available to answer requests
Licensed Beds: 309
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: October 2001
Mentor Contact Name: Casey Joseph, MPH
Mentor Contact Email: cjoseph@bhs1.org
Mentor Contact Phone: (413) 447-2964

Additional Information:

• Implemented in 2001 by a multidisciplinary team.
• Team consists of senior medical resident, charge nurse from ICU/CCU, respiratory therapist and primary nurse.
• Nurse driven process, using RRT criteria for activation.
• Critical Care Committee has ongoing oversight and responsibility for the team.
• Maydays on the inpatient nursing units have decreased 52%.
• Maydays in the ICU have decreased 27%.
• Reduction in the number of maydays per 1000 discharges from 4.58/1000 in 2000 (prior to the team) to 2.84/1000 in 2005.
• Over the last 3 years total Team calls have increased 27%.
[2/14/06]

*                *                  *

Blessing Hospital – Quincy, IL
Availability Status: Available to answer requests
Licensed Beds: 435
Teaching / Non-Teaching Status: Teaching
Setting: Rural
Start Date of Intervention Work: June 2005
Mentor Contact Name: Dorothy Bybee RN
Mentor Contact Email: dbybee@blessinghospital.com
Mentor Contact Phone: (217) 223-8400 ext 8103

Additional Information:

• Blessing Hospital successfully implemented the Rapid Response Team initiative rapidly and met with immediate positive results.
• The initiative was phased in over nine weeks and Family activation added February, 2006.
• Response from physicians, nursing staff and patients has been overwhelmingly positive.
• Comments from nursing staff demonstrate the Rapid Response Team as a patient centered and nurse supportive initiative.
• Taking critical care skills to the patient regardless of their location has made a positive impact on patient outcomes.
• There has been a total of 72 activations of the Rapid Response Team June 2005-December 2005.
• 10% increase in code survival to discharge
• A 22% decrease in codes outside of the ICU
[2/14/06]

*                *                  *

Brookwood Medical Center – Birmingham, AL
Availability Status: Available to answer requests
Licensed Beds: 550
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: January 2003
Mentor Contact Name: Kristina Cherry
Mentor Contact Email: Kris.Cherry@tenethealth.com
Mentor Contact Phone: 205-877-1454

Additional Information:

We found several qualitative benefits of our Rapid Response Team:  improved communication and collaboration between the critical care nursing, respiratory, and floor nurses. Another qualitative finding was improved nurse-to-physician communication subsequent to the implementation of our SBAR tool. We also conducted satisfaction surveys and found a high level of satisfaction with the RRT from the requestor, responder and physicians. In addition, we feel our staff have a heightened patient safety focus and are more likely to look for subtle signs of clinical deterioration.

We found several significant and sustained benefits in implementing a Rapid Response Team.  In the non-ICU areas, we realized a 38% reduction in codes and a reduction of 1.36 codes per 1,000 discharges. We also found a 4% overall reduction in code events and a reduction of 2.52 codes per 1,000 discharges.  Over a 13-month period, we experienced a 1.5 fold increase in RRT consultations with a subsequent decrease in non-ICU codes. We also found a reduction in the number of emergent transfers to the critical care units.

[12/7/07]

*                *                  *

Carondelet St. Joseph’s Hospital – Tucson, AZ
Availability Status: Available to answer requests
Licensed Beds: 425
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: March 2005
Mentor Contact Name: Chris Scullary
Mentor Contact Email: cscullary@carondelet.org
Mentor Contact Phone: 520 872-6684

Additional Information:

Our Rapid Response Team (Advanced Clinical Assessment Team) is comprised of an ICU charge nurse and a respiratory therapist and was initiated within six weeks using a rapid cycle implementation process. The team was fully functional on 3/1/05, with 24/7 coverage. In the first 12 months, we have averaged 18 calls per month (11.3/1000 admissions) with respiratory change in status (36%) the most frequent reason for call.  Transfer to ICU occurred 48% of the time.  High degree of satisfaction by bedside nurses and by attending physicians. Because of the heightened awareness of early intervention, an early recognition of clinical deterioration program was initiated in January 06 and will train all nurses over the next six months.

Code Blue Calls:
CY-04 = 177    CY-05 = 137
CY-04 14.8 codes/month   CY-05 11.4 codes/month
CY-04   9.5 codes/1000 admissions   CY-05  7.0 codes/1000 admissions
[3/30/06]

*                *                  *

Carteret General Hospital – Morehead City, NC
Availability Status: Available to answer requests
Licensed Beds: 117
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: May 2005
Mentor Contact Name: Tonya Fluellen, RN, MSN
Mentor Contact Email: tfluellen@ccgh.org
Mentor Contact Phone: 252-808-6470

Additional Information:

Our hospital has increased awareness of the importance of early intervention to avoid cardiac/resp. events or otherwise deterioration in patient status.

Our floorstaff is now seeking help and assistance sooner which has enhanced collaboration, among nursing units as well as the respitory department

Our Rapid Response Team consists of a CCU RN and a Respiratory staff member. We initially started out with a PCU RN as a part of this team, but found it worked best with just the two members.

We did not add any FTE’s, but instead utilized the same members from the CCU staff and RT staff that would respond if there were a code blue. These staff members were initially anxious that they would be called for everything and not be able to care for their patients.  After the staff came to understand that a Rapid Response Team call was better than an actual code, this anxiety began to dissipate.

During the early stages of implementation, we developed a multidisciplinary team that consisted of a staff member from every nursing unit as well as the respiratory department.  This team presented inservices and education on each nursing unit to explain what was going to be implemented. We also developed story boards and fliers that were posted throughout the hospital to educate hospital employees, doctors and the public about what we were implementing and why. During the education on the units, the staff was made aware of the number to call for the rapid response team and the fliers and storyboards all over the building also displayed this number. A CCU staff member and RT staff member are assigned a rapid response cell phone each shift, 7 days a week.

The Director of Medical Services and VP of Nursing met with the doctors to let them know what we were starting and to get their buy in. They were initially skeptical, but after the first few success stories, their buy in began to show.

Codes outside the CCU decreased by 50% between May 2005 and May 2006.
Our number of RRT’s is more than 50% greater than number of codes outside of CCU
During months with a higher number of RRT calls, the number of codes were down.
[8/19/06]

*                *                  *

Catholic Medical Center – Manchester, NH
Availability Status: Available to answer requests
Licensed Beds: 330
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: June 2005
Mentor Contact Name: Peggy Lambert
Mentor Contact Email: plambert@cmc-nh.org
Mentor Contact Phone: 603-663-6408

Additional Information:

In a community hospital setting, within 6 months we were able to plan and implement a Rapid Response Team. This included working with medical staff leaders providing education to the medical staff, introducing SBAR to the nursing staff, developing tools and the processes we would follow. We adapted a documentation tool from the IHI website and have been tracking elements to help evaluate our success with this program. We also worked with Kathy Duncan, KathyDDuncan@comcast.net,  from IHI to develop a dashboard.

This information is from our Rapid Response Team dashboard first quarter results:
Number of Codes Outside ICU:  Down 10%.  Although the number of codes has gone up, the number of codes outside the ICU has dropped 10% .  Very sick pts are getting to the ICU BEFORE they code.
Average before RRT 2.42
Average after RRT 2.17
Percent Decrease -10.34%

Mortality rate for the entire hospital is down 10% since implementation of Rapid Response Team.
Average before RRT 2.83% (278 deaths/9821 discharges)
Average after RRT 2.54% (124deaths/4877 discharges)
Percent Decrease -10.18%
[3/14/06]

*                *                  *

Centra Health – Lynchburg, VA
Availability Status: Available to answer requests
Licensed Beds: 403
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: May 2005
Mentor Contact Name: Patty Bumgarner, RN, BSN, CCRN
Mentor Contact Email: patty.bumgarner@centrahealth.com
Mentor Contact Phone: 434-947-3048

Additional Information:

Keys to Rapid Response Team Success:

• Early education of critical care staff and med-surg nurses of need for RRT and benefits of RRT
• Dedicated Critical Care nurses who had experience and were trained in FCCS course.
• Open communication between nurses in critical care and nurses on other units
• Calls made every shift to remind staff that the RRT is available.
• Piloted it 11p-7a on 4 floors, then 7p-7a, then 24-7, and then all over the hospital.  After piloting it 11p-7a at one hospital, we began a trial 11p-7a at the second hospital.
• We have a physician and nurse champion.
• Conducted breakfast meetings with all charge nurses and discussed RRT and what we were trying to accomplish.
• We have succeeded because nurses want to care for patients and do the best they can for them.  Nurses see this as using all possible skills to help the patients.

Also:  Evaluations from the floors have been excellent.  We did not add FTES.

Codes on the floors outside of the ICUs have decreased by 35%.
[4/27/06]

*                *                  *

Charleston Area Medical Center – Charleston, WV
Availability Status: Available to answer requests
Licensed Beds: 913
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2004
Mentor Contact Name: Kim Kendrick, Six Sigma Black Belt
Mentor Contact Email: kim.kendrick@camc.org
Mentor Contact Phone: 304-388-4310

Additional Information:

Implemented MET team pilot at Memorial 11/2004 consisting of RN/Charge Nurse from ICU and Respiratory Therapist
Implemented MET team for General Division 2/2005
Implemented pro-active rounding for both hospitals 12/2005 (Memorial 7-3; General 11-7) seeing all patients transferred from the ICU in the last 24 hours, all patients on high-flow O2 therapy and/or nebulizer treatments and any patient that a nurse was concerned about or mentioned when ask "Who is the sickest patient on your unit?"
Developed criteria for rounding and a list is generated by respiratory for daily rounds
Currently working to implementing MET order sets around top 5 call diagnosis groups to allow MET team to begin intervention with the support of the ED physician group when attending physician is not available.

MET team calls have increased from 2-4 per month to 55 calls for the month of December 2005.  Both hospitals met the 10/100 ADC goal for 12/2005 and we are now tracking calls weekly as we increase.
Codes outside the ICU have decreased from 44.7% prior to initiation to 37.5% current month.
[1/31/06]

*                *                  *

The Chester County Hospital – West Chester, PA
Availability Status: Available to answer requests
Licensed Beds: 221
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: May 2005
Mentor Contact Name: Dianne Lanham RN, MSN, CPHQ
Mentor Contact Email: dlanham@cchosp.com
Mentor Contact Phone: 610-431-5588

Additional Information:

The Chester County Hospital took a unique approach in forming our RRT which was implemented on May 2, 2005. The members wanted to ensure that immediate medical treatment could be given without waiting for physician orders after evaluation of the patient. Consequently, critical care nurse practitioners who can order drugs and treatments, respond as team leaders, Monday through Friday from 6 am-8pm. House physicians respond at all other times. Our response team includes the critical care nurse practitioner or house physician, respiratory therapist, satellite cardiac monitoring nurse, the patient's primary nurse, and a nursing assistant. Our criteria for calling the RRT are similar to other hospitals team criteria, the first being "the nurse is worried about the patient."

Our Rapid Response Team has been a huge success with our nurses. One nurse praised the team as "the best thing since sliced bread" on the survey which we send to each RRT caller, along with a thank you note. Our RRT is by far the single most important effort we have made in improving care at our hospital. Not only has it rescued patients whose condition might otherwise have deterioated to the point of no return, but it has helped raise the bar on all the care we provide our patients.

We average 49 calls per month, with most being called for cardiac related issues. In the last two quarters of 2005, we had 2.8 codes per 1000 discharges compared to 6.7 experienced by other hospitals in our comparison group. We also had 33.3% of codes outside of ICU compared to our comparison group of 47.1 codes outside of ICU for the same time period. We collect data on all calls and conduct a monthly review of 100% of RRT charts. We have an RRT taskforce whose members collect and discuss the data and determine is any improvements are needed.
[3/30/06]

*                *                  *

Children's Healthcare of Atlanta at Egleston – Atlanta, GA
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 216
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: December 2006
Mentor Contact Name: Christiane Levine RN, Senior Process Improvement Consultant 
Mentor Contact Email: Christiane.Levine@choa.org
Mentor Contact Phone: 404-785-6992

Additional Information:

In 2006, Children's Healthcare of Atlanta (CHOA) began working on a comprehensive approach to the deteriorating patient.  Using the root cause analysis process, we identified similar factors contributing to past codes.  These factors led us to four major opportunities for improvement:

1. Increase timely recognition of the deteriorating patient:  Computer-based education programs about shock and deterioration for staff and physicians.   Purchased patient simulators that mimic the patient in compensated and uncompensated shock.  Created awareness around recognition of shock through other means, e.g., education blitz.
2. Develop effective communication skills under pressure:  Adopted SBAR as communication tool and educated all staff and physicians on its use. 
3. Educate about escalation of care: All staff were made aware of the escalation policy and tree.  It was posted more prominently on our intranet.  The "Speak Up!" Campaign was designed to empower staff at all levels (e.g., PCTs, RNs, RCPs) to speak up for the benefit of the patient, with administration supporting them.  Many staff are afraid to speak up because they care concerned about making a working relationship tense in the future or of a less than optimal response to their concerns.  We wanted to create an environment of psychological safety for the patient's caregiver.   Staff was educated through articles in our newsletter, posters, the intranet, staff meetings, and campaign tables.  We tied the campaign together using the color orange.  
4. Implement Rapid Response Teams:  We have two campuses - one teaching model and one community model.  This posed a challenge to standardize the process and team makeup, but we were able to create a model that would serve the needs of both.  We launched our team in December 2006, after only 90 days of preparation.  Our RRT consists of a Pediatric ICU nurse and Respiratory Therapist.  We do not have an MD in our model and no FTEs were added.  The RRT has strengthened the relationship between PICU staff and the floor staff and we put no parameters on calling the RRT. ("Any call is the right call!")

1. Our unexpected mortality rate had decreased by 50% from 2006.

2. Since implementation of our Rapid Response program in December 2006, we have had over 140 calls.

3. Our codes outside the ICU have increased (baseline = 0.15 per thousand patient days in 2006, 0.3 thus far in 2007).  We believe that this is because we now are capturing more than before.   These codes were called to intervene prior to the patient experiencing full cardiac or respiratory arrest; we have not seen that level of prevention in the past, nor have we had the ability to track those patients as we were only monitoring those that had a code blue evaluation filled out by the code blue team.   It is to this that we are attributing the increase.

CHOA has realized that the RRT is a tool for continued improvement.  It has shed light on barriers that we were not aware of before implementation and we are learning in which areas staff need more education.  We are further investigating the codes outside the ICU and expect these to decrease as we continue RRT education and the Speak Up Campaign.
[7/7/07]

*                *                  *

Children's Healthcare of Atlanta at Scottish Rite – Atlanta, GA
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 234
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: December 2006
Mentor Contact Name: Christiane Levine RN, Senior Process Improvement Consultant
Mentor Contact Email: Christiane.Levine@choa.org
Mentor Contact Phone: 404-785-6992

Additional Information:

In 2006, Children's Healthcare of Atlanta (CHOA) began working on a comprehensive approach to the deteriorating patient.  Using the root cause analysis process, we identified similar factors contributing to past codes.  These factors led us to four major opportunities for improvement:

1. Increase timely recognition of the deteriorating patient:  Computer-based education programs about shock and deterioration for staff and physicians.   Purchased patient simulators that mimic the patient in compensated and uncompensated shock.  Created awareness around recognition of shock through other means, e.g., education blitz.
2. Develop effective communication skills under pressure:  Adopted SBAR as communication tool and educated all staff and physicians on its use. 
3. Educate about escalation of care: All staff were made aware of the escalation policy and tree.  It was posted more prominently on our intranet.  The "Speak Up!" Campaign was designed to empower staff at all levels (e.g., PCTs, RNs, RCPs) to speak up for the benefit of the patient, with administration supporting them.  Many staff are afraid to speak up because they care concerned about making a working relationship tense in the future or of a less than optimal response to their concerns.  We wanted to create an environment of psychological safety for the patient's caregiver.   Staff was educated through articles in our newsletter, posters, the intranet, staff meetings, and campaign tables.  We tied the campaign together using the color orange.  
4. Implement Rapid Response Teams:  We have two campuses - one teaching model and one community model.  This posed a challenge to standardize the process and team makeup, but we were able to create a model that would serve the needs of both.  We launched our team in December 2006, after only 90 days of preparation.  Our RRT consists of a Pediatric ICU nurse and Respiratory Therapist.  We do not have an MD in our model and no FTEs were added.  The RRT has strengthened the relationship between PICU staff and the floor staff and we put no parameters on calling the RRT. ("Any call is the right call!")

1. Our unexpected mortality rate had decreased by 50% from 2006.

2. Since implementation of our Rapid Response program in December 2006, we have had over 140 calls.

3. Our codes outside the ICU have increased (baseline = 0.15 per thousand patient days in 2006, 0.3 thus far in 2007).  We believe that this is because we now are capturing more than before.   These codes were called to intervene prior to the patient experiencing full cardiac or respiratory arrest; we have not seen that level of prevention in the past, nor have we had the ability to track those patients as we were only monitoring those that had a code blue evaluation filled out by the code blue team.   It is to this that we are attributing the increase.

CHOA has realized that the RRT is a tool for continued improvement.  It has shed light on barriers that we were not aware of before implementation and we are learning in which areas staff need more education.  We are further investigating the codes outside the ICU and expect these to decrease as we continue RRT education and the Speak Up Campaign.
[7/7/07]

*                *                  *

Children's Hospitals and Clinics of Minnesota – Minneapolis, MN
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 319
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2005
Mentor Contact Name: Suzanne Spencer
Mentor Contact Email: suzanne.spencer@childrensmn.org
Mentor Contact Phone: 612-813-6632

Additional Information:

Implementation of rapid response teams is raising important questions about our organizational commitments to physician communication, organizational trust, family involvement and definitions of success.  We know we are successful because we are stimulating dialogue about doing what is best for the child and family rather than what is most convenient for the professional or beneficial to the organization.

• Use of Rapid Response Teams has climbed from 7 calls in November 2005 to 18 calls in March 2006.
• Initial data suggest reduction in mortality among coded patients since education on RRTs began in August 2005.
• Average response time (call to arrival at bedside) for team is 5 minutes.
• Staff satisfaction with RRT calls is very high among both requestors and responders.
[6/2/06]

*                *                  *

Cincinnati Children's Hospital Medical Center – Cincinnati, OH
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 451
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: June 2004
Mentor Contact Name: Uma Kotagal, MD, Vice President for Quality and Transformation
Mentor Contact Email: uma.kotagal@cchmc.org
Mentor Contact Phone: 513-636-0178

Additional Information:

Team developed which includes PICU Fellow, Senior Peds Resident, PICU Staff Nurse, Respiratory Therapist and Manager of Patient Services (Nursing Supervisor).

Team is called using one phone number 24 hours/7days per week.  This activates all pagers for team members.  Promised response is within 15 minutes.   Medical Response Team can be called by any member of the care team.

Triggers for calling the response team include patient "not acting right," "getting worse," increased work of breathing or "you are concerned."

Codes outside the ICU per 1000 patient days is being used as the measure since preventing them was the object of implementing the team.  Rate went from 0.27 per 1,000 patient days pre-implementation to 0.11 per 1,000 patient days post implementation through February 2006. 

During implementation all Medical Response Team participants and all unit staff involved in the call completed surveys related to how well the process worked.  Evaluations were very positive from both groups.  Team activations continue to occur on a regular basis across the organization and each activation is reviewed. 

Next steps:  Improve the ability of staff to identify when the child is "getting worse".  We consider the implementation of the team complete but there is still work to be done to completely eliminate failure to rescue.
[5/12/06]

*                *                  *

Columbus Regional Hospital – Columbus, IN
Availability Status: Available to answer requests
Licensed Beds: 325
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: September 2005
Mentor Contact Name: Jennifer Dunscomb
Mentor Contact Email: jdunscomb@crh.org
Mentor Contact Phone: 812-376-5575

Additional Information:

• Developed the Critical Advisory Network (CAN), which is the same team as rapid response, comprised of a critical care nurse and a respiratory therapist.
• Approved by medical staff, CAN members are able to obtain diagnostics as needed and implement protocols such as respiratory, chest pain, ACLS, hypotension, etc.
• CAN members are consultants to the primary med-surg nurse and mentor the floor nursing staff in better communication with the physicians using the SBAR tool (Situation, Background, Assessment, Recommendations).
• Developed CAN competencies and training program prior to implementation.

Post implementation:
• 0 medical-surgical codes
• 92% survival rate for patients from a CAN event
• Codes per 1,000 discharges decreased from 2.75-2.25
• 50% of patients transferred to ICU all requiring ICU monitoring/intervention (as measured by APACHE)
• 40 CAN calls from September to January 1
• High satisfaction from medical and nursing staff
[1/31/06]

*                *                  *

Community Hospital East – Indianapolis, IN
Availability Status: Available to answer requests
Licensed Beds: 400
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: July 1996
Mentor Contact Name: Cleo Ann Burgard
Mentor Contact Email: cburgard@ecommunity.com
Mentor Contact Phone: (317) 621-5329

Additional Information:

• Tremendously enhanced confidence in the medical surgical staff nurse in their care and critical thinking skills
• Enhanced relationships with ICU and medical surgical staff nurses
• Enhanced relationships between the ICU physicians and the medical surgical staff
• Tremendous MD satisfier
• Recruitment and retention strategy for nursing
• Reduction in total hospital codes
• Reduction in codes in medical surgical to near zero for months at a time
• Reduction in percent of patients who need to be transferred to a higher level of care
[2/14/06]

*                *                  *

Contra Costa Regional Medical Center – Martinez, CA
Availability Status: Available to answer requests
Licensed Beds: 166
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Steven Tremain, MD
Mentor Contact Email: stremain@hsd.cccounty.us
Mentor Contact Phone: 925-370-5122

Additional Information:

Success occurred because the Rapid Response Team is composed principally of a critical care nurse and a respiratory therapist.  Physicians become involved when the RRT determines involvement is necessary. Staff was trained on SBAR and SBAR is used as the communication method for nurses to report to the RRT.  All nurses who summoned the RRT are unconditionally supported.  RRT was piloted on one medical unit, and was determined by the staff to be so helpful that it was rapidly spread (pulled) to the entire hospital.  We are now beginning to implement patient and family activation of the RRT.

RRT calls in 2006 = 62.  Of these, 31 were transferred to a higher level of care.  Before RRT implementation, 2005 had 9 floor codes with 7 deaths.   In 2006, there were only 3 floor codes. All 3 patients were discharged alive. There were no deaths due to floor codes in 2006.  Note:  A consultant was touring the hospital when a Code Blue was called.  A staff nurse said, "That's unusual.  We don't have them anymore."  He asked, "Why not?"  She answered, "The RRT is called before a patient gets that sick."  At that point, the operator announced that the Code Blue was cancelled; it had been called in error.
[3/13/07]

*                *                  *

Elkhart General Hospital – Elkhart, IN
Availability Status: Available to answer requests
Licensed Beds: 302
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Leigh Poeppelman, RN, MSN - Critical Care Manager
Mentor Contact Email: lpoeppelman@egh.org
Mentor Contact Phone: 574-523-3195

Additional Information:

• Elkhart General Hospital implemented the Rapid Response Team house-wide in August of 2005.
• Team = ICU RN; Progressive Care Unit RN; and RT PLUS the bedside RN/LPN and the Physician
• In the first 24 days, there were NO codes called outside of ICU and ED!
• Decrease in codes and inappropriate transfers to a higher level of care   
• Team building and communication a plus!
• 2006 growing the team:  New protocols approved.  Team members ACLS EP
• Created a special pin for Rapid Response Team members
• Celebrated the one-year anniversary of our team with a breakfast.  We also used the anniversary as an opportunity to provide more education about the team throughout the hospital (delivering cookies along the way.)

• 17 calls per month in 2005  
• 1.3 Codes per 1000 patient days in 2004  0.6 Codes in 2005
• 68% patients stabilized in 2005
[3/17/07]

*                *                  *

Exempla Saint Joseph Hospital – Denver, CO
Availability Status: Available to answer requests
Licensed Beds: 563
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2002
Mentor Contact Name: Maria Kinsella
Mentor Contact Email: Kinsellam@exempla.org
Mentor Contact Phone: 303-866-8514

Additional Information:

Exempla Saint Joseph Hospital began its Rapid Assessment Team or RAT team in November 2002 based on articles from Australia documenting the benefits of these outreach teams. In the 3+ years since then, we have seen a significant reduction in the number of unmonitored codes.  An aggressive marketing campaign directed to the floor nurses have them fully on board with this initiative.  The data from this team has also supported other initiatives such as medication reconciliation. We have been a leader in this field, presenting a poster of our work at this year's Society of Critical Care Medicine conference in January and VHA has used our team as speakers for their regional 100K Lives start-up conferences.

From its inception, we have seen a significant reduction in the number of unmonitored codes and we have had 6 months of ZERO floor codes!

In the last 12 months we are averaging 0.325 unmonitored codes per 1000 patient days without a corresponding increase in patient mortality. Our team usage is up from 106 calls in 2003 to 163 calls in 2005.
[2/14/06]

*                *                  *

Fairview Ridges Hospital – Burnsville, MN
Availability Status: Available to answer requests
Licensed Beds: 150
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: September 2005
Mentor Contact Name: Helen Strike, VP Patient Care Services
Mentor Contact Email: hstrike1@fairview.org
Mentor Contact Phone: (952) 892-2104

Additional Information:

The team has met with tremendous success and has proven to be one of the most profound changes we have made at our facility to deal with real and perceived communication and care issues.

The positive reception has been unanimous from physicians, staff, and patients.
We have had calls at our front door, in our gift shop, and for staff members who have collapsed or become acutely ill.  On November 22, 2005, we expanded our team to include all children age 1 month and above.  We are also creating special OB and neonatal Rapid Response Teams.
Our Pain Nurse Practitioner is creating pain protocols for the RRT to use to assist those patients with acute and/or intractable pain.

Since implementation:
45 calls
1 cardiac arrest outside ICU
24 patients stayed in their rooms
15 transferred to the ED
6 treated in outpatient area or transferred to the ED for further treatment
Ratings of 5 (very successful) from all staff who have called the RRT and from all staff who respond as members of the RRT.
[1/31/06]

*                *                  *

Fauquier Hospital – Warrenton, VA
Availability Status: Available to answer requests
Licensed Beds: 86
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: January 2006
Mentor Contact Name: Catherine Walsh
Mentor Contact Email: walshc@fauquierhospital.org
Mentor Contact Phone: 540 349 0584

Additional Information:

Chart reviews of Fauquier Hospital patients experiencing a code blue revealed compelling evidence of patients exhibiting signs of destabilization which were not acted upon by the nursing staff early enough to prevent a code blue.
The start-up process was given to our Code Blue Committee.  Criteria for calling the team was decided upon, the most important of these being:  “the staff member is worried about the patient.”  The team members were carefully selected and trained on expectations.  Team members must be available to respond immediately (call time to bedside target is 5 minutes).  Team members need to have critical care skills/expertise, and must have quality communication skills, while responding in a friendly, professional manner.   Most importantly, they provide non-judgmental, non-punitive response to the person initiating the call.

Since the institution, of the RRT team, we have had very positive comments from staff.  We send the primary nurse and the initiator of every call, a letter of “thank you” and evaluation form.  In addition, we have received kudos from our Medical Staff.  Most importantly, we have reduced the code blue calls on the floors so far this year by 50% compared to this time last year!
[8/31/06]

*                *                  *

Franklin Square Hospital Center – Baltimore, MD
Availability Status: Available to answer requests
Licensed Beds: 343
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: July 2005
Mentor Contact Name: MaryBeth Thier
Mentor Contact Email: marybeth.thier@medstar.net
Mentor Contact Phone: 443-777-7902

Additional Information:

Franklin Square rolled out the rapid response team hospital wide quickly; after just 4 planning and structuring meetings, the team was implemented. Only minor adjustments were needed following initiation in response to the staff's feedback.
Education was done house wide by the educators and ICU staff nurses with very positive feedback and immediate buy-in from all levels of staff.
Education and information was reinforced in multiple arenas including hospital Town Hall Meeting and Rapid Response celebration. Staff at all levels, physicians, residents, PAs and nurses quickly bought in and supported the process.
Family involvement was implemented following a successful pilot on 2 units.
Percentage of Codes outside the ICU has decreased from 54% to 39%
Percentage of patients who coded and survived to discharge increased from 23% to 44%
Average monthly calls – 24
[2/14/06]

*                *                  *

Harborview Medical Center – Seattle, WA
Availability Status: Available to answer requests
Licensed Beds: 367
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Laura Nelson
Mentor Contact Email: lauran@u.washington.edu
Mentor Contact Phone: 206.731.3755

Additional Information:

We've had an existing very successful ‘STAT Nurse’ program in place for about 10 years.  We built on that program by adding a respiratory therapist.  By creating an SBAR tool with clinical triggers for calling the RRT, all levels of acute care staff (including residents) felt they were given permission to call for support prior to a or pre-code situation.

We are up to an average of 83 RRT calls per month.  We were a high performer on the University Hospital Consortium's RRT initiative with 0% of our patients during the reporting period going on to arrest anytime after the RRT intervention.  We also were pleased that 24% of calls were due to "concerns about the patient" which indicates a high level of staff acceptance to this type of support.  We are currently developing metrics to assess our impact on cardiac/respiratory codes although we are certain that these are reduced.

[1/31/06]

*                *                  *

Henry Ford Hospital – Detroit, MI
Availability Status: Available to answer requests
Licensed Beds: 904
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: December 2004
Mentor Contact Name: Jack Jordan
Mentor Contact Email: jjordan1@hfhs.org
Mentor Contact Phone: 313-874-3925

Additional Information:

In December of 2004, rapid response teams were launched. Today two rapid response nurses are in the hospital 24/7. All nurses on general practice units have been trained on how, when and why to alert the rapid response team.

The rapid response team has been a huge success and has been equally well-received by residents and nurses.  Henry Ford Hospital uses a single nurse responder combined with a concurrent page to the resident assigned to the patient.  If the care needs to be escalated, the ICU fellow will be contacted.

This model appears well-suited to a teaching hospital environment.  Initial concerns about the team interfering with the medical education process have all but disappeared.  Residents have found that having extra resources available to watch over the highest acuity patients allows them to take more aggressive action without over burdening the responsible nurse.  The rapid response team can help allow a nurse to keep up with their other patients. 

The success of the rapid response team has both a support to nurses as well as means to observe nursing practices. A report from the rapid response team on nursing practice issues is an agenda item at every Nursing Practice Council.  This input has been used to focus efforts on skills validation.

• Responded to over 1200 calls
• Reduced the blue alert rate by 30%. 
• Been a key contributor to a hospital length of stay reduction of nearly 0.5 days
[1/31/06]

*                *                  *

Holyoke Medical Center – Holyoke, MA
Availability Status: Available to answer requests
Licensed Beds: 202
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: February 2004
Mentor Contact Name: Dawn Chartier RN BS, Clinical Improvement Manager and Linda Pellegrino, RN, Nurse Manager, Intensive Care Unit
Mentor Contact Email: Chartier_dawn@holyokehealth.com
Mentor Contact Phone: 413-534-2510

Additional Information:

Holyoke Medical Center has successfully implemented a Clinical Evalution Response Team (CERT). It was first trialed in February 2004 and, within 7 months, it had been spread to all in house patient units. The idea was readily accepted by staff and physicians. It has helped us to improve patient outcomes and to work better as a team.  Each call is logged and data trends analyzed. Identified learning needs have prompted educational inservices and non-ICU staff support. ICU transfers have been avoided, patients have been helped sooner and staff a has support system in place. CERT has sustained the last 2 1/2 years and has grown to part of the culture of HMC.

To date we have received over 360 CERT calls
82% of the calls did not require a transfer to the ICU
When comparing January - September 2003 to 2006:
• Total code blue survival rates have increased by 57%
• Medical/Surgical code blue survival rates have increased by >100%
• Code Blue patients discharged alive has increased by 10%
• Total in-patient mortality rates have decreased by 15%
• Medical/Surgical mortality rates have decreased by 16% (2004-2006)
[10/28/06]

*                *                  *

Jewish Hospital – Louisville, KY
Availability Status: Available to answer requests
Licensed Beds: 442
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: June 2003
Mentor Contact Name: Paula Heinz
Mentor Contact Email: paula.heinz@jhsmh.org
Mentor Contact Phone: 502-587-4935

Additional Information:

Implemented Rapid Response Team successfully and continued operational success for over 2 years. Team protocols and monitoring forms have been developed and outcome measures tracked monthly.

Initial reduction in codes outside the ICU from 2.0/1000 pt days to 1.4/1000 pt days and codes reduced overall from 3.2/1000 pt days to 2.8/1000 pt days.
[1/31/06]

*                *                  *

Johns Hopkins Children's Center of the Johns Hopkins University – Baltimore, MD
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 170 pediatric beds
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: October 2004
Mentor Contact Name: Elizabeth Hunt
Mentor Contact Email: ehunt@jhmi.edu
Mentor Contact Phone: 410-955-2393

Additional Information:

• Our Pediatric Rapid Response Team is comprised of a PICU fellow, PICU nurse, PICU respiratory therapist, senior pediatric resident, junior pediatric resident, pediatric intern, pharmacist, nursing shift coordinator, chaplain and security. 

• "Family concern" is on the formal list of reasons to trigger a Rapid Response Team call and we have educated our nursing and resident house staff that if a family member is scared or worried they should call us. We have had a number of calls where family concern was listed as either a primary or secondary reason for calling. 

• We monthly review all calls and arrests and have set up a computerized tracking system to identify trends and progress. 

• Since our transformation into a Rapid Response Team, we have seen an increase in calls to the team and a decrease in the number of children experiencing an actual cardiopulmonary arrest.

• Deployment of our Pediatric Rapid Response Team has led to a 50% increase in calls to the team and a 30% decrease in the combined rate of respiratory and cardiopulmonary arrests on the wards.
[4/17/06]

*                *                  *

Kaiser Foundation Hospital - West Los Angeles – Los Angeles, CA
Availability Status: Available to answer requests
Licensed Beds: 282
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: June, 2005
Mentor Contact Name: Sheila L. Hill, MSPH, MBA
Mentor Contact Email: Sheila.L.Hill@kp.org
Mentor Contact Phone: 323-857-2645

Additional Information:

• Kaiser Foundation Hospital - West Los Angeles is fortunate to have strong support and buy-in from our leadership and stands behind the Rapid Response Team efforts as well as the rest of the IHI initiatives.

• In addition to the nursing staff, the team physicians have given positive feedback to the staff and the rest of their team members.

• Using rapid cycle methodology, we were able to have a very smooth roll-out to our entire hospital over time because of the lessons quickly learned from each individual unit's roll-out.

• As time goes by we are seeing increasing (and very appropriate) use of the RRT, which is the best measure of its usefulness as measured by the floor staff.

We are hopeful that our data will support our current perception that the RRT is a benefit to our staff and to our patients. From a data perspective, the overall effects of the RRT are still difficult to conclude at this point, due to seasonal variations in census and mortality, but we are hopeful that with continued efforts and additional time, our data will be a reflection of our optimism in this initiative.

Based on our RRT RN Staff Satisfaction Survey, over 90% of our nursing staff (hospital wide) feel that the RRT has been positive for patient safety and improved patient outcomes.
[5/12/06]

*                *                  *

Kent Hospital - Warwick, RI
Availability Status: Available to answer requests
Licensed Beds: 359
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Virginia Wilcox, RN, CCRN (Nurse Manager - Intensive Care Unit)
Mentor Contact Email: vwilcox@kentri.org
Mentor Contact Phone: (401) 737-7010 x 5180

Additional Information:

Kent Hospital implemented a Rapid Response Team program in August of 2005. The team is made up of an ACLS-certified Critical Care nurse who has at least 3 years of Critical Care experience, a Respiratory Therapist and a Physician's Assistant. No FTEs were added.  The nursing and education departments developed policies and procedures for the Rapid Response Team, developed a teaching plan, reference materials, a competency and a checklist to assist with the implementation.

Kent started the program with one nursing unit as a pilot for a period of one month. Both team members and nursing unit staffs were surveyed during this initial phase to help determine if there were problems to solve before expanding the program to other units. There was very positive reaction to the team. The program was then expanded hospital-wide.

The Rapid Response Team has become a valuable asset to Kent Hospital. It has empowered staff to activate this team when they feel there has been an acute change in their patient's condition. It is viewed as taking critical care expertise to the bedside.

Each orientation program includes education about the Rapid Response Team. It is viewed very positively as a recruiting tool.  The Rapid Response Team approach has become a great teaching tool for staff of nursing units. The SBAR system of reporting and the "no call is a bad call" approach has become valuable to non-critical care nursing staff.

Cardiac arrests decreased from 7.6 per 1,000 discharges to 3.0 per 1,000 discharges in the subsequent 13 months post implementation of the Rapid Response Team.

Overall hospital mortality the year before the Rapid Response Team was 2.82% and decreased to 2.35% by the end of the Rapid Response Team year.

The percentage of Intensive Care Unit admissions that were unplanned decreased from 45% to 29%.

Utilization of the Rapid Response Team has increased from 6 calls the first month to an average of 25 calls per month.
[1/18/08]

*                *                  *

LSU Health Science Center - Shreveport – Shreveport, LA
Availability Status: Available to answer requests
Licensed Beds: 448
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: March 2006
Mentor Contact Name: Sheree Jordan
Mentor Contact Email: mjorda@lsuhsc.edu
Mentor Contact Phone: 318-675-7610

Additional Information:

Since starting our Rapid Response Team, we have found a positive impact in both patient outcomes and nursing satisfaction.  As a teaching institution, we had to be creative in involving the residents by not excluding them or their education.  Our team uses a collaborative approach for plan of care using a critical care RN and Respiratory therapist.  Using the collaborative approach, the bedside nurse contacts the patient's resident.  The resident, RN, and RT then meet at the patient's bedside along with the bedside nurse to develop a rapid plan of care for the patient.  If there is a difference of opinion at the patient's bedside, the ICU physician is consulted.  We have not yet incorporated families into our educational process, but we are looking at that for the future.  Our RRT was developed and initiated without any additional FTE's.

At present, we are seeing a greater than 50% reduction in our non - ICU codes.
We have dropped our codes per 1000 patient average from last year from 11.8 to 7.42.
[2/6/07]

*                *                  *

Lee Memorial Hospital – Fort Myers, FL
Availability Status: Available to answer requests
Licensed Beds: 427
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: June 2005
Mentor Contact Name: Jonathan Hollander
Mentor Contact Email: Jonathan.Hollander@LeeMemorial.org
Mentor Contact Phone: (239) 336-6703

Additional Information:

Lee Memorial was the first hospital in the Lee Memorial Health System to implement the MET concept.
We began immediately with the following units: Progressive Care, Orthopedic, Med-surg Trauma, Neuro and Neuro Step-Down, Infectious Disease and Oncology.  In approximately two weeks we had expanded to Radiology and Endoscopy.  In February 2006 we will expand to our rehab hospital.
On a quarterly basis, Jonathan Hollander revisits the floors and continues the campaign for the MET team concept.  We continue to provide weekly updates to the Directors of these areas. 
We continue to have the MET team serve as a retention and recruitment tool to provide support for the staff in our facility.

We have had 115 MET calls since we began on June 26, 2005 through January 23, 2006, which averages approximately 16 MET calls per month.
On average, for 20% of the MET calls, the patients are transferred to the ICUs.
We have seen a 56% reduction in Code Blues (Cardiac/Respiratory Resuscitation) and estimate we have saved 11 lives since we began the program.
We have received staff (Med-Surg/PCU) feedback on approximately 46% of our MET calls and 97% of the feedback strongly agree we are timely, we connect with the staff, we empower the staff and we show appreciation to the staff for calling the MET team.

[1/31/06]

*                *                  *

McLeod Regional Medical Center – Florence, SC
Availability Status: Available to answer requests
Licensed Beds: 371
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: June 2004
Mentor Contact Name: Mark Williams, RN, MBA/HCM, BSN
Mentor Contact Email: mwilliams@mcleodhealth.org
Mentor Contact Phone: 843-777-2449

Additional Information:

The Rapid Response Team had a successful four month pilot.  The Rapid Response Team successfully expanded out to cover the adult population using the four adult ICU's and Respiratory Therapy as the responding team.  The Rapid Response team has received overwhelming support from the physicians.  McLeod was featured in the Best Hospitals Issue of US News and World Report and in USA Today for its Rapid Response Team.

Since beginning the Rapid Response Team, there have been 489 calls.  Since October 2005 the Rapid Response Team has responded to 130 calls, with 82% of those patients able to remain on the nursing unit after intervention.  McLeod has seen a 34% decrease in the number of Cardiac Arrest outside the ICU when comparing the periods of February 2004 through December 2004 and the period of  February 2005 through December 2005.

[2/14/06]

*                *                  *

Mercy Medical Center – Nampa, ID
Availability Status: Available to answer requests
Licensed Beds: 152
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: July 2005
Mentor Contact Name: Deanna Graham
Mentor Contact Email: Deannagraham@chiwest.com
Mentor Contact Phone: 208-463-5889

Additional Information:

We are a mid-size community hospital with an average daily census of about 60.  Our Rapid Responders consist of an ICU trained nurse and a respiratory therapist.  At night, resources may be flexed from the ICU nurse to the house supervisor, depending on the census and availability of the ICU nurse to leave the unit.  Since implementing rapid response teams in July 2005, we have had 29 rapid response calls.  Only one progressed to a code situation.  We have continualy worked on ways to encourage the staff to call a rapid response through staff education, marketing and story sharing.

There were 29 rapid response calls in the first 12 months of the program.  At the same time, our mortality rate decreased by 18%.  The number of codes decreased by 53% (15 per quarter to 7 per quarter).  We have closely monitored our mortalities on the 2 x 2 mortality matrix and in 12 months our non-ICU, non-DNR rates went from 23% to 18%.
[10/28/06]

*                *                  *

Miller Children's Hospital – Long Beach, CA
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 281
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2005
Mentor Contact Name: Mihai Marinescu
Mentor Contact Email: mmarinescu@memorialcare.org
Mentor Contact Phone: 562 933-1908

Additional Information:

• We have strong support from our Pediatric Intensive Care physicians who are in house 24 hours a day, 7 days a week. 
• The hospital administration has made the AHA Pediatric Advanced Life Support required for all RNs in Pediatrics.  This education has increased the confidence of the staff on Rapid Cardiopulmonary Assessment and when to call for early intervention. 
• We developed a pocket-size card for all staff on when to call for the Rapid Response which includes signs and symptoms of Respiratory distress, shock, acute changes as well as abnormal vital signs. 
• We also developed signage at each phone on how to activate the team and the exact location of the patient in need.

During November '05 and April '06 there were 89 cases that required transfer to PICU as a result of RRT activation – 2 patients expired.  There were 3,324 discharges during that same period with a total of 13,982 bed days. 

Measures:
# of codes outside ICU between November 2005 and April 2006  = 0
RRT Activation per 1000 inpatient discharges  26.8
RRT Activation per 1000 patient days  6.4
Survival of RRT patients to discharge   97.80%
[6/2/06]

*                *                  *

Mission Hospitals – Asheville, NC
Availability Status: Available to answer requests
Licensed Beds: 800
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: December 2005
Mentor Contact Name: Stuart Scott, RN Coordinator of Rapid Response Team
Mentor Contact Email: stuart.scott@msj.org
Mentor Contact Phone: 828-213-4307; 828-207-2229

Additional Information:

Mission Hospitals Rapid Response Team is participating in the NC Rapid Response Team Collaborative project.  The Rapid Response Team was implemented on the St. Joseph Campus November 2005. A second team for the Memorial Campus began in May 2006. During this time, St. Joseph had 703 calls and performed 5,804 follow-up visits. Memorial Campus answered 418 calls and performed 3,606 visits.

Nursing, physicians and respiratory staff have embraced the program. In the near future, plans are to prepare the teams to integrate referral calls from families as well as patients.

Overall, code blue calls outside the ICUs have decreased by 32.5%.

The Rapid Response Team has received 50% of its calls from day shift and 50% from night shift.  Utilization of RRT each day is similar as well.  The statistics are as follows:  14% of total calls occurred on Sunday, Monday, Wednesday, Friday and Saturday.  Thirteen percent of total calls occurred on Thursday and 17% on Tuesday. 

The Team’s majority of evaluations in response to calls lasted between 16-30 minutes at approximately 29% of the time.  Twenty two percent of the calls had evaluations by the team lasting from 1 - 2 hours. 

The greatest accomplish of the RRT is the patient disposition with 75% of patients being able to remain on the unit without having to transfer to ICU.  Seventeen percent of patients did transfer to ICU and 6% of patients transferred to a progressive care unit. 

Of the staff that has been randomly surveyed each month since May 2006, 100% would call again and felt that the Rapid Response Team treated them with respect.  Of these respondents, 99% agreed the experience with the RRT was a great learning opportunity and felt that the communication with the RRT was professional. 

Follow-up visits are defined as patients who are followed by the Rapid Response Team that leave the ICUs and transfer to step-down or regular nursing units.  These are initiated not by a call from the staff but rather as a transfer notice of a patient out of ICU. 

One particular unit has excelled in the utilization of the Rapid Response Team and their resulting numbers reflect the positive interaction.  The unit is 9 Step Down - a medical/cardiac unit - on the St. Joseph Campus.  This incredible unit has the next to highest RRT utilization rate in the hospital