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Acute Myocardial Infarction	Medication Reconciliation (ADE)
Boards on Board	Pressure Ulcers
Catheter-Associated UTI	Rapid Response Teams
Central Line Infections	Surgical Complications
Congestive Heart Failure	Surgical Safety Checklist
High-Alert Medications	Surgical Site Infections
MRSA	Ventilator-Associated Pneumonia

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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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]

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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, rendered 128 calls to the RRT in 7 months and have seen a 75% decrease in code blue calls when measured at the same time frame as last year.  The Mortality Rate for the entire hospital has decreased from 2.4% to 2.0% in the last seven months.
[3/13/07]

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Monongalia General Hospital – Morgantown, WV
Availability Status: Available to answer requests
Licensed Beds: 207
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: March 2006
Mentor Contact Name: Camille Western, RN, Patient Safety Coordinator
Mentor Contact Email: westernc@monhealthsys.org
Mentor Contact Phone: 304-598-1388

Additional Information:

The Monongalia General Hospital Rapid Response Team chose criteria based on actual symptoms identified in chart reviews of patients with cardiac and respiratory arrests.  One criteria used is the family is concerned about the patient. Patients and families are educated on this through the patient handbook, posters, and education by staff. When families verbalize concerns to a nurse, the nurse calls the Rapid Response Team.  We feel this involves our families in actively promoting patient safety.

Thorough education is done to encourage calls to the team for any one symptom of a deteriorating patient. Separate education plan was developed for the team members who respond to the Rapid Response calls.
 
No additional FTE's are used to staff the Rapid Response Team.  Rapid Response Team members include ICU nurse, CCU nurse, respiratory therapist, house supervisor, and the primary nurse for the patient.  The average time spent per call is 30 minutes.

The physicians in our hospital embrace the team and will initiate calls for a deteriorating patient.

During the first year, we had 48 calls to the Rapid Response Team.  Most frequent reason for calls has been respiratory symptoms and the second most common reason has been a change in level of consciousness.

51% of the calls resulted in the patient being moved to a higher level of care.
 
Survival rate to discharge for patients was 92%.

We have noted a decrease in Code Blues outside the ICU  by 15% and have noted increased survival rate of the Code Blue from <40% prior to RRT and now >50% survival to discharge. 

Without intervention, all team members felt 100% of the RRT calls would have resulted in Code Blues.
[6/26/07]

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Mountain View Hospital District – Madras, OR
Availability Status: Available to answer requests
Licensed Beds: 25
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: July 2006
Mentor Contact Name: Suzi Bean, RN, BSN, Director of Quality Management
Mentor Contact Email: sbean@mvhd.org
Mentor Contact Phone: 541-475-3882 Ext. 2511

Additional Information:

• The Mountain View Hospital District Rapid Response Team is made up of the House Supervisor, ED physician and Respiratory Therapist. No FTEs were added.

• Mountain View hospital was able to roll out Rapid Response Teams very quickly, with great physician and staff support and with phenomenal results.

• The Rapid Response Team initiative has brought additional positive outcomes important for nursing staff recruitment and retention; Nurses feel empowered, there is a heightened awareness for early intervention and an enhanced emphasis on shared learning.

• SBAR communication tool initially adopted for Rapid Response Team is now being used as the primary communication tool between physician and nursing staff in the family birthing suites, and for communicating with receiving physicians for inter-hospital transfers.

• Reduction in the number of codes (outside the ICU) per 1000 discharges from 5.1/1000 for the year prior to the existence of the team to 0.7/1000.

• Utilization of the Rapid Response Teams has increased from 3 in the first 6 months of the program to 13 in the past 6 months of the program.
 
• Reduction in the percentage of patients transferred to a higher level of care.

• Reduction in the mortality rate from 1.6 in the year prior to establishment of Rapid Response Teams to 0.78 in the year since establishing the teams (a 52% decrease).

[8/16/07]

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The Nebraska Medical Center – Omaha, NE
Availability Status: Available to answer requests
Licensed Beds: 548
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2004
Mentor Contact Name: Terrie Johansen
Mentor Contact Email: tjohansen@nebraskamed.com
Mentor Contact Phone: 402-559-3432

Additional Information:

Initially implemented a Medical Emergency Team (MET) in August 2004.  Observed low utilization and lack of knowledge about program benefits as it relates to patient safety.  In early summer of 2005 participated in UHC Commit to ACTion for RRT and as a result, changed policies and procedures for the RRT, changed name of MET to RRT and created mandatory education program for nursing about the RRT.  RRT utilization has incrementally increased since August 2005 and remains consistent.  Nursing staff express increased satisfaction with the availability of this resource.  The organization is now preparing to implement a Pediatric RRT in February 2006.

RRT usage before August 2005: averaged at 2 calls per month.
RRT usage after August 2005:  averaging at 14 calls per month.
Codes per 1000 discharges remain variable, ranging from 7.0 to 16.4 but with an average of 9.3 codes per 1000 discharges.
[1/31/06]

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North Carolina Children’s Hospital – Chapel Hill, NC
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 136
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Tina Schade Willis, MD
Mentor Contact Email: twillis@unch.unc.edu
Mentor Contact Phone: 919-966-7495

Additional Information:

On August 1st, 2005, we launched our Pediatric Rapid Response Team (PRRT) after several months of designing calling criteria, activation protocols, and education. 

The team responds not only to patients with clinical signs of deterioration, but also in response to staff or family member concern.  The families of our patients have expressed appreciation for the availability of the team. 

The team has been a trigger for a cultural change throughout our entire system.  There are no false alarms and the caller is always treated with respect and not scolded for calling the team.  The system change associated with the team has improved communication and teamwork between the ICU and the non-ICU areas of the hospital. 

The team is composed of the Pediatric Intensive Care Unit (PICU) Fellow MD Team Leader, PICU Charge Nurse, PICU Respiratory Therapist, Senior Pediatric Resident, and the patient's primary team.  The team is available 24 hours per day, seven days per week. 

The new system assists with education of nurses and resident physicians in recognizing signs of clinical deterioration in pediatric patients.  It also allows for cooperative early resuscitation of these patients in the presence of critical care physicians and staff to improve outcomes and resuscitation skills of physicians in training.

The new system also has a database to collect all information related to calls as well as cardiac and respiratory arrests.  Through this new system we have also identified several patterns that highlight possible system safety issues that have been addressed to improve hospital-wide safety.  Without the systemized activation system and data collection, these safety issues may not have been discovered.

Although the team has only been in place for 6 months, we have received 32 activations of the team. 

The team has responded to the patient is less than 5 minutes in every activation. 

The team has been called to all pediatric inpatient acute care areas as well as the radiology department and subspecialty clinics that are located in the North Carolina Children's Hospital. 

Pediatric cardiac arrests are uncommon and a longer period of time will be needed to determine if a significant decrease in pediatric cardiac arrests have occurred. 

In the 3 years prior to the initiation of the PRRT, critical care personnel were called to assess only 8% of patients prior to their cardiac or respiratory arrests outside of the ICU setting.  Since the initiation of the PRRT, there have been two respiratory arrests (patients requiring intubation) and one cardiac arrest (patients requiring chest compressions) outside of the ICU setting and 100% of these patients had critical care personnel called to the bedside prior to the respiratory or cardiac arrest.  That is, critical care staff has been called to the patient's location prior to all arrests since the development of the team.  

The most common reason for calling the team is staff worry about the patient's condition.  The second most common is change in oxygen saturation.  The patient's nurse is the most common caller of the team and the resident physicians are the second most common callers of the team. 

Our academic center has been more accepting of this system cultural change than many centers and as an example of this, 2 of the PRRT activations have been initiated by the patient's attending physician.
[3/30/06]

Read the North Carolina Children's Hospital profile in the 2008 IHI Annual Progress Report

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North Country Regional Hospital – Bemidji, MN
Availability Status: Available to answer requests
Licensed Beds: 117
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: April 2005
Mentor Contact Name: Nancy Mickelberg, RN, Director of ICU
Mentor Contact Email: nmickelberg@nchs.com
Mentor Contact Phone: 218-333-5693

Additional Information:

North Country Regional Hospital successfully rolled this intervention out with tremendous buyin from both staff and physicians.

It has been a win-win initiative for staff, physicians and most important our patients.

Besides rescuing patients in a timely manner, before they are able to deteriorate and code, we are looking at trends in where and when the rapid responses are called and for what diagnoses and using the information in our ongoing nursing education and core competencies.

We have had 46 rapid responses since the formal inception of the rapid response team.

In that same amount of time we've only had two codes on non ICU, non outpatients.
[1/31/06]

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Onslow Memorial Hospital – Jacksonville, NC
Availability Status: Available to answer requests
Staffed Beds: 110
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: December 2005
Mentor Contact Name: Crystal Hayden RN, MSN
Mentor Contact Email: Crystal.hayden@onslowmemorial.org
Mentor Contact Phone: 910-577-2676

Additional Information:

The Onslow Memorial Response Team is initiated by the primary care nurse for any acute changes in patient condition and consists of an ICU nurse and Respiratory therapist (when needed).  

Challenges have included:
 
Adapting to change in processes can be difficult for some and if concerns are not addressed early and sufficiently, the new process may not be effective or lead to the desired results.

Make the implementation of the Rapid Response Team as simple as possible.  The more steps a nurse has to go through to initiate the Rapid Response Team, the less likely s/he is to use this resource.

Compiling data from the primary care nurse’s point of view enables the Rapid Response Team to identify areas of the process for improvement.

Using common terminology such as the word “rapid” may at times lead to miscommunications and misunderstandings of the team and its purpose.  This word becomes a trigger and can be mistaken for the Rapid Response Team.

The Onslow Memorial Hospital Rapid Response Team has effectively reduced the number of Code Alerts outside of our Emergency Department and ICU by 54% since December 2005.  As a result of increased calls per month, Onslow Memorial Hospital  experienced only eight codes outside of the ED and ICU during 2007.  On average in 2007, 50% of the patients were able to remain in their room following a Rapid Response intervention. Patient outcomes have also improved, avoiding prolonged hospital stays and associated increased costs.
[08/15/08]

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Oregon Health and Science University – Portland, OR
Availability Status: Available to answer requests
Licensed Beds: 509
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: June 2005
Mentor Contact Name: Kitling Lum, RN
Mentor Contact Email: lumk@ohsu.edu
Mentor Contact Phone: (503) 494.8579

Additional Information:

Our champions for this initiative are the two Division Directors from the ED/Neuro ICU and Respiratory Therapy Department and our physician champion is a CSICU intensivist. With their guidance, skill, and vision, this program was introduced and embraced by senior leadership.

Our Rapid Response Team was implemented in June of 2005. The team consists of one CSICU RN, one Respiratory Therapist, and the primary service; the MICU fellow is called when physician back-up is needed. Initially, a core team of ICU staff nurses agreed to respond to the RRT calls, be the code 99 responder and take a patient assignment. However, it was soon realized that the calls were increasing as was the time allocated to the calls and the decision was made that the RRT nurse would not take a patient assignment.

We have just implemented a process for follow-up on each patient discharged from the ICU and the RRT nurse is conducting those follow-ups. The staff also does follow-up within 12 hours of each RRT call.

Staff interested in applying for an RRT position on the team must submit a request to the nurse manager and meet certain criteria, such as excellent communication skills, a desire to be on the team and good clinical decision-making.
 
Education of hospital staff consisted of a pre-implementation survey, posters throughout the hospital, and education to leadership and management about the goals of RRT and the IHI initiatives. Prior to implementation, members of the team visited staff in clinics, nursing units and other hospital areas to introduce themselves, inform staff about the team and its purpose and how to access them. Telephone stickers were made with the access number and provided to all areas of the hospital. We have also developed cards for ID badges that outline the criteria for when to call the RRT, with our motto being "if you are concerned, so are we."   Since implementation, the team has been invited to many nursing staff meetings, and physician teams meetings.

A one-year follow-up survey will be sent to all staff and responses will be compared to our first survey.  If changes or improvements are needed, we will implement those knowing we are working as a team with all members of the hospital.

The team has responded to 340 calls since implementation of RRT in June 2005.
As of June 2006, codes per 1000 patient discharge days are 1.2 compared to 1.6 one year ago. When comparing Jan-June 2005 to the same period this year, codes outside of the ICU have decreased from 27 to 20 respectively.
48% of calls result in transfer a higher level of care and 35% of patients remain in room.
The monthly number of RRT calls has increased steadily over time. Last year, the average number of calls per month was 24 compared to 32 calls calls per month this year.
[10/28/06]

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Our Lady of Lourdes Memorial Hospital – Binghamton, NY
Availability Status: Available to answer requests
Licensed Beds: 267
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: October 2004
Mentor Contact Name: Susan Fuchs, RN Director of ICU
Mentor Contact Email: sfuchs@lourdes.com
Mentor Contact Phone: 607-798-5420

Additional Information:

We call our RRT the Medical Emergency Team (MET). We began testing MET and the SBAR communication technique on the night shift for approximately 4 weeks. Other shifts began to request MET, therefore we spread to all 3 shifts. We are a community hospital, we do not have house staff or intensivists. Our team consists of an ICU RN and RT. The program has been very successful. Staff education is ongoing and does occur with each call. The MET mentors the primary RN during the call. We have seen an increase in the number of MET calls. The feedback from staff and patients/families has been very positive.

Over the past calendar year, January through December 2005:

We had an average of 13 MET calls per month. We continue to see an increase in the number of MET calls each month.

Our average response time is 3.4 minutes. Our goal is 10 minutes
Our average time spent on a MET call is 20 minutes. Our goal is 30 minutes.
[1/31/06]

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Parkview Hospital – Fort Wayne, IN
Availability Status: Available to answer requests
Licensed Beds: 694
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Katie Reader
Mentor Contact Email: katie.reader@parkview.com
Mentor Contact Phone: 260-373-3270

Additional Information:

Parkview Hospital initiated its Rapid  Response Team in October 2005. Blending a successful "Stat Nurse" program with the technology of eICU, the RRT brings a critical care experienced nurse (stat nurse), the intensivist, by way of a robot, and respiratory therapy to the patient's bedside. The bedside nurse is in immediate communication with the intensivist with the first call. This process allows immediate action in way of physician orders, treatments, transfer if neccassary. The attending physician is paged at the same time the RRT call is made. The attending physician then works with the intensivist or assumes care of the patient situation.

Since October of 2005, RRT as expanded to all hospitals in the Parkview Health System. There is support by eICU intensivist and a robot at all but one location at this time. The ability to have a physician as a member of the RRT most definitely has made an impact on patient outcomes.

187 RRT calls system wide 10/05 - 7/06
Codes outside the ICU:  Decreased from 42% prior to RRT to less than 25% 7/06
Codes per 1000 discharges;  Decreased from 10.2 to 7.3 in 7/06
Evaluation of process and RRT by bedside nurses is outstanding. The staff views this process as effective to improve patient outcomes, supportive to all nurses, especially new nurses.
[10/28/06]

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Ridgeview Medical Center – Waconia, MN
Availability Status: Available to answer requests
Licensed Beds: 129
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: March 2005
Mentor Contact Name: Melissa Pitts
Mentor Contact Email: melissa.pitts@ridgeviewmedical.org
Mentor Contact Phone: 952-442-2191 x5142

Additional Information:

Ridgeview had an informal resource team prior to the launch of the 100K campaign.  A formal, structured process for a rapid response team was implemented in May of 2005.   The team consists of a critical care nurse and a respiratory care practioner.  There has been steady growth in the utilization of the team from the medical and surgical nursing units.  The rapid response team has overwhelming support from its customers and a high level of satisfaction among the team members.

Overall Ridgeview mortality has decreased.  Since July 2005, only one code has occurred outside of the critical care unit.
[2/14/06]

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Riley Hospital for Children – Indianapolis, IN
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 245
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: March 2006
Mentor Contact Name: G. Kris Bysani, MD, Associate Director of PICU
Mentor Contact Email: gbysani@iupui.edu
Mentor Contact Phone: (317) 278-7128

Additional Information:

The Rapid Response Team at Riley Children’s Hospital, or the Children’s Acute Response Team (CART), was initiated March 1, 2006.   This effort received participation and support of hospital leadership and a multidisciplinary team of respiratory therapists, physicians, nurses and managers. The team is comprised of the Senior Resident, Pediatric Critical Care Unit (PICU) Charge Nurse and, PICU Charge Respiratory Therapist.  The Pediatric Intensivist provides support to the team.  The Pediatric Intensivist is consulted for each CART and/or a member of the bedside team as needed.

Since implementation, the CART has participated in 67 activations Sept. 2006.  CART members and patient care unit staff were surveyed during the first months of this program.  The program received overwhelming positive feedback.  The CART is making a difference.  The following represents CART outcomes:

1)  Codes outside the ICU were reduced to an average of 3.0 per month to 0.8.
2)  Codes per 1000 discharges are at a rate of 4.92 as compared to 7.82 for September year to date 2006.
3)  Fifty percent of CART patients were transferred to an intensive care unit.
4)  Mortality trends will be followed to assess impact on this measure over time.
[3/13/07]

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Rochester General Hospital – Rochester, NY
Availability Status: Available to answer requests
Licensed Beds: 528
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: September 2005
Mentor Contact Name: Jeanne Powers, RN, MS, CCRN, CMS, MICU Clinical Nurse Specialist
Mentor Contact Email: Jeanne.Powers@RochesterGeneral.org
Mentor Contact Phone: (585) 922-3811

Additional Information:

Background - Modeled after Rapid Response Teams (RRTs), an Early Nursing Intervention Team (ENIT) was developed to improve patient outcomes.  It is a nurse-led team comprised of the ICU nurse and the general care unit nurse.  ENIT takes the RRT concept a step further by "rounding" twice daily on patient care units.

Purpose - The purpose of ENIT is twofold:  To improve patient outcomes by facilitating early transfer to the ICU, thereby reducing adverse events, and to increase nursing staff satisfaction by bringing critical-care expertise to general duty units thus supporting the general duty nurse.  This program has been positively received by nursing and medical staff.

Results - There has been a 50% reduction in codes on general care units in the first seven months of the ENIT program compared to the same time frame in the previous year  In 2004, there were 26 codes (from June to December) while in 2005, there were just 13 codes.  Other patient data currently being analyzed include survival to discharge, length of stay, and time to transfer to ICU following ENIT activation.
[8/31/06]

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Sacred Heart Medical Center – Spokane, WA
Availability Status: Available to answer requests
Licensed Beds: 623
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: Denise Dominik
Mentor Contact Email: dominid@shmc.org
Mentor Contact Phone: 509-474-3733

Additional Information:

SHMC has rolled out our adult rapid response team with great results.  Within the first 30 days of go live we have 86 activations (we have approximately 500 adult beds) and 28 of those patients were transferred to a higher level of care.  Our rate of codes has dropped outside the ICUs and staff satisfaction with the team is very high.  The team rounds on ICU transfer patients and post activation patients as well as attends codes to identify if a patient should have had an activation eariler.

There were 16 lives saved within that first month.  We reduced rate of codes from 11.3 to 6 per 1000 discharges.  Improved nursing satisfaction is noted by follow-up surveys with 80% return rate.

In March 2006, we saw 108 RRT activations with 31 transfers to higher level of care and our codes outside the ICU went from 7.3 codes per 1000 discharges in Feb. 05 to 2.5 codes per 1000 discharges in Feb. 06.  We saved an additional 31 lives in the month of March.  Our staff evaluations on the team continue to be overwhelmingly positive. 
[4/27/06]

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St. Catherine of Siena Medical Center – Smithtown, NY
Availability Status: Available to answer requests
Licensed Beds: 311
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: December 2005
Mentor Contact Name: Gara Edelstein, Sr. VP, Patient Care Services, Chief Nursing Officer
Mentor Contact Email: gara.edelstein@chsli.org
Mentor Contact Phone: 631-862-3155

Additional Information:

We have created a Rapid Response team consisting of an ICU or CCU nurse, Respiratory Therapist, Hospitalist or Nurse Practitioner and Nursing Supervisor.  The team may be called any time a nurse requires immediate attention for his/her patient.  The patient is assessed and because there is a hospitalist or NP on the team, immediate treatment begun.  The patient may remain in their room or moved to the critical care unit following the team call.  There has been an overwhelmingly positive response in our non-teaching hospital from the attending physicians, experienced nursing staff as well as the new graduate nurses and has proven to be a significant retention strategy for our nursing staff.

We have had 32 RRT calls throughout the facility in the first quarter of 2006 with the following outcomes:

1)  63% reduction in cardiopulmonary emergencies (CE) outside the critical care units
2)  48% reduction in emergency intubations outside the critical care units
3)  88% of patients discharged home or to skilled nursing facility
4)  Tremendous increase in nursing and physician satisfaction related to the ability to expedite care to their patients by calling an RRT.
5)  Improved communication to attending physician regarding patient's status
[3/30/06]

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Saint Francis Hospital Memphis – Memphis, TN
Availability Status: Available to answer requests
Licensed Beds: 561
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: April 2004
Mentor Contact Name: Tonya Parson APN (MRT Coordinator) or Gayle King, RN
Mentor Contact Email: tonya.H.parson@tenethealth.com  or Gayle.King@tenethealth.com
Mentor Contact Phone: 901-765-2108

Additional Information:

Saint Francis Hospital was able to roll out its RRT within 3 weeks of its inception.
Saint Francis Hospital was able to obtain great results very quickly.
Within the 3-week span, we piloted the RRT on all floors during the hours of 11A-11P, Monday thru Thursday with good results.
After 3 weeks of doing a small of test of change, we expanded to include the weekends during the same hours for about 4 weeks.
After 8 weeks, the team was rolled out house wide with 24hour/7day coverage.
Physicians and staff view the RRT as a positive resource in the hospital.
Patient rounds are viewed as the necessary ingredient to early patient intervention (or rescue).
After 20 months, Saint Francis Hospital added an advanced practice position to the RRT.

We showed a 30% reduction in codes outside of the ICU by the end of the first year.
Our team facilitated transfer of, on average, 75% of patients that come to ICU.
We round on 100% of patients that transfer out of ICU at 24 and 48 hours after transfer
During the first month, the RRT had 27 calls, we now average 93 calls per month.
[2/14/06]

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Saint Francis Medical Center – Grand Island, NE
Availability Status: Available to answer requests
Licensed Beds: 140
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: May 2005
Mentor Contact Name: Shari Lock, RN, BS
Mentor Contact Email: slock@sfmc-gi.org
Mentor Contact Phone: 308-398-5584

Additional Information:

Saint Francis Medical Center was the first rural hospital in our system to successful initiate a RRT.
The team is viewed as an essential tool for quality care.
The Rapid Response Team has served as a nursing staff recruiting tool.
The facility has successful activated the team in less than 5 minutes by a unique method of determining the team using the Nursing Supervisor.  When a request for an RRT on our emergency phone line comes to our operator, the operator pages the respiratory therapist and the Nursing Supervisor. The Nursing Supervisor details a nurse from either CICU or ER to answer the call. This has been very effective because the supervisor knows the staffing ratio for both areas and is aware of who can best leave their current workload and assist in a call.
Our physicians have reported the team has prevented transfers to a higher level of care and earlier notification of patient concerns.

In our Fiscal year 2006 we had 85 Rapid Response Team calls and 2 months into 2007 we have had 31 additional calls.
Saint Francis Medical Center experienced a 6% decrease in mortality in FY 2006.
We have experienced an 8% reduction in codes outside of our critical care areas.
 [10/28/06]

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St. Joseph Hospital – Cheektowaga, NY
Availability Status: Available to answer requests
Licensed Beds: 207
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: November 2004
Mentor Contact Name: Denise Bartosz
Mentor Contact Email: db4071@chsbuffalo.org
Mentor Contact Phone: 716-891-2683

Additional Information:

This is probably the first initiative that the medical staff, nursing staff and ancillary staff have all given very positive feedback.  Our implementation team took a lot of time developing the program and did a number of small tests of change.  It was important to us that the first few times the RRT was called that all went well. We had planned a one month trial on 2 floors for the evening shift.  The first two calls went so well that full nursing floor roll-out took place just one week after the first call.  Within one month, all nursing floors and ancillary departments (radiology, cardiology, physical therapy, interventional radiology, GI lab, sleep lab) were educated and able to call the RRT.

RRT Call per 1000 Discharges:
Nov - Mar the rate of calls per 1000 discharges is 17.

Codes per 1000 discharges:
Jan - Oct 2005  rate was 8.81
Nov 2005 - Mar 2006 rate is 7.81
[5/12/06]

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St. Joseph Hospital – Orange, CA
Availability Status: Available to answer requests
Licensed Beds: 469
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: May 2004
Mentor Contact Name: Carmen Ferrell & Tammy Alvarez
Mentor Contact Email: carmen.ferrell@stjoe.org or tammy.alvarez@stjoe.org
Mentor Contact Phone: 714-771-8000 ext. 8076

Additional Information:

Utilizing principles of reliability which include rapid cycle testing, staff engagement and fostering a culture of safety, we were able to contribute to the benefit and welfare of patients and attain a return on investment for the hospital.

The Rapid Response process where expert consultation by a Critical Care Nurse and Respiratory Therapist occurs when the call is placed by the medical/surgical nurse, assisted in improving collaboration and communication amongst caregivers with a patient who is clinically deteriorating on the medical surgical unit.  These interactions have increased staff satisfaction with MET responders.

The success of the Rapid Response (MET) team in the Med-Surg population has led to spreading the concept to other areas of service. For example, we have an inpatient behavioral health unit and the concept of BERT (Behavioral Emergency Response Team) and our new team is the GERT (Gynecological Emergency Response Team). The responders for both of these teams are specialized in their respective areas (Behavioral Health and OB-GYN) and respond to these kinds of patients in other areas of the hospital (i.e., a psych patient on the med-surg unit).

Next Steps:

• Added family advisors to our team
• Implementing Early Warning Systems (EWS) trigger tools (January 2007)
• Pilot of Patient/Family-activated MET team calls (March 2007)

Lastly, we have spread this concept to 8 additional hospitals within our health system.

Reduction of mortality from 19% (1st QTR 04) to 11% (2nd QTR 06).
Over two-year period, decreased codes in the medical/surgical units by 60% while increasing the amount of Rapid Response Team calls.

Decrease in patient transfers into critical care based on rapid response team outcomes: 

• In 2004, approximately, 100% of patients evaluated by the MET team were transferred to the ICU
• In 2005, approximately 75% were transferred to ICU
• In 2006, only 25% of patients who were evaluated by the MET team were transferred to ICU.

We saved 166 lives by preventing the patient from coding or transferring them into critical care.
We have a cost savings to the hospital of $234,500.

[3/30/07]

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St. Joseph's Mercy Health Center – Hot Springs, AR
Availability Status: Available to answer requests
Licensed Beds: 279
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: August 2006
Mentor Contact Name: Lynn Pellegrino, RN, MSN, APRN-BC
Mentor Contact Email: lpellegrino@htsp.mercy.net
Mentor Contact Phone: (501) 622-1840

Additional Information:

The Rapid Response Team was piloted on one unit that has a high volume of medical surgical patients in July 06 and was implemented house-wide in August 06. The team consists of an ICU nurse, respiratory therapist, and the nursing house supervisor. Initially, we had to work out the process for contacting the team.  We now use the overhead paging system and this works well.  The team has been well received by the medical and clinical staff.

Since the initiation of the Rapid Response Team, the number of codes in the hospital has decreased. The majority of the calls are in the p.m. and the most frequest reason for calling the team is either a change in patient status or staff concern.

Codes have decreased by 40% since August 06 when the team was instituted hospital-wide.
[3/13/07]

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St. Luke Hospital-East – Ft. Thomas, KY
Availability Status: Available to answer requests
Licensed Beds: 310
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2004
Mentor Contact Name: Tony Hyott
Mentor Contact Email: hyottt@healthall.com
Mentor Contact Phone: 859-572-3955

Additional Information:

Key for the Rapid Response Team initiative was the integration of quality measurement, performance improvement and Six Sigma methodology.  This approach enhanced the process and results were achieved well ahead of established target dates.  Moving forward, the breadth of our organizational involvement supports the sustainability of our achievements.  Clinical leaders have ownership of the outcomes and the Critical Care Patient Care Review Committee will be charged with overseeing the continued management of the RRT initiative.  This initiative has been fully integrated into our clinical practice.

At St. Luke Hospital - East, monthly Rapid Response Team calls have increased 33% when adjusted for volume.  During this same period, monthly non-ICU Code Blue calls have decreased by 54%.  From September 2005 to present, there is a statistically significant inverse correlation between RRT calls and non-ICU Code Blue calls, i.e., when RRT calls are high, non-ICU Code Blue calls are low.
[3/30/06]

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St. Luke’s Hospital – Cedar Rapids, IA
Availability Status: Available to answer requests
Licensed Beds: 560
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: February 2005
Mentor Contact Name: Sherrie Justice
Mentor Contact Email: justicsl@crstlukes.com
Mentor Contact Phone: 319-369-8367 or 1-800-369-7217 ext. 8367

Additional Information:

• Phased in quickly with excellent results and cases to share for educational purposes.
• Unit nurses and families report greater confidence regarding care of the patient with changing conditions and with transfers
• Rapid Response Team enjoys the opportunity to educate/mentor while on the call.
• Family involvement is encouraged.
• St. Luke’s non-Critical Care codes went down from 24% in 05 to 15% in 06
• 129 calls in first year
• 51% treated and remain on the unit
• 49% transferred to higher level of care
• Average time team spends on the call is 25 minutes
• Transfer times to critical care, if needed, has been cut in half
• Code blue rate per 1,000 discharges was only 1.79 when team initiated, which is significantly lower than that reported nationally.
[8/31/06]

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St. Mary Medical Center – Apple Valley, CA
Availability Status: Available to answer requests
Licensed Beds: 186
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: John Brady & Donna Grant
Mentor Contact Email: john.brady@stjoe.org; donna.grant@stjoe.org
Mentor Contact Phone: (760) 242-2311 ext 5146 & 5927

Additional Information:

Our key to success is the recognition of call triggers by the frontline staff and was the chief process change.

The team developed emergency RRT orders (standardized procedures) enabling them to be able to address emergent needs. These orders also are used when visitors or employees fall ill on campus (CMS 250 yard rule). 

Another important element is call data analysis & continuous process improvement (key driver).   

The adult team is composed of an ICU Team Leader/ or Staff Nurse, Administrative Coordinators serve as back-up, and a Respiratory Therapist.

The peds team: There is a dedicated Pals Certified ED RN and a Respiratory Therapist.
Security and Spiritual Care Services along with Primary RN & Team Leader of the patients unit are also members of team.  An Emergency Department Physician Champion is the team's medical advisor.  

No additional FTE's were allocated to the RRT. In the future we may be able to add staff in order to do some pro-active rounding on the units. One of our sister ministries, Mission Hospital won the Codman Award in 2008 for their work in proactive rounding and focusing on sepsis patients. The St. Joseph Health System may decide to spread this to other ministries as a system wide initiative.  

We initially piloted the RRT on one unit which was a medical surgical floor. We piloted for three months then spread unit by unit untill global.

St. Mary Medical Center (SMMC) has analyzed our Rapid Response Team data and identified many process improvement activities including:

Discovered an increase in RRT calls with opiate niave patients requiring the use of reversal agents following a new pain program. (Provided both medical and nursing re-education & implemented PI tracking.)

Temporary staff not aware of Rapid Response Team program. (Provided re-education for temp staff and worked with their agency.)

Hypoxic late call trends and failure to rescue. (Enforced need to call entire Rapid Response Team when oxygen sats fall below 90%.)

Review all out-of-unit calls for potential missed triggers. (Provided re-education.)

Backsliding staff calling for a casual consult rather then call entire Rapid Response Team. (Provided re-education.)

Identify potential failures to communicate. (Examples reported to nursing and medicine committees).

Identify failures to rescue. (Staff documented triggers but failed to act, share the stories, use Just Culture ask What and Why)

Identify failures to plan. (Report all calls to Rapid Response Team within 24 hours of admission that require transfer to ICU; report to Critical Care Committee.)

Perform annual mortality review using IHI tools for 2X2 matrix.

ICU nurses/RRT members are using sepsis screening tools for early detection of sepsis.
We started a formalized sepsis team in 2008 and are using the IHI sepsis bundles.
Condition H or patients and families may call for (HELP) begins January 1, 2009. 

Data on utilization of the Rapid Response Team demonstrating increase over time:
2005  6 calls per month average
2006  8 calls per month
2007  9 calls per month
2008 19 calls per month

Data on code blues per 1,000 discharges demonstrating reduction over time:
SMMC's codes per 1,000 discharge have dropped 63% in 3 years
2005 10.4 codes per  1,000 discharge
2006   6.4 codes per  1,000 discharge
2007  4.25 codes per 1,000 discharge
2008   3.9  codes per 1,000 discharge 

Data on non-ICU code blues demonstrating reduction over time:
2005  49 codes (raw number of out of unit codes)
2006  33 codes
2007  18 codes
2008  27 codes

Our raw mortality has dropped 34% in 3 years
2005 1.8 Baseline raw mortality
2006 1.5
2007 1.3
2008 1.2

Our observed to expected mortality ratio (O/E) is .64 currently. Anything under 1.00 is lower than expected, above 1.00 is higher than expected
 
Our Hospital Standardized Mortality Ratio (HSMR) is 50.4 for first half 2008. The average US hospital is 70.5. The lower the score the lower the mortality.

[2/23/09]

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St. Peter Community Hospital – St. Peter, MN
Availability Status: Available to answer requests
Licensed Beds: 22
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: March 2005
Mentor Contact Name: Benjamin W. Chaska, M.D., MBA, CPE, Medical Director and Patient Safety Officer
Mentor Contact Email: bchaska@stpeterhealth.org
Mentor Contact Phone: 507-934-8416

Additional Information:

Adaptation: Recognize, Respond and Treat- Prompt recognition of a decline in patient condition to decrease patient transfers to a higher level of care.

Actions Taken:
• Changes in patient status are rapidly identified and reported to physician.
• Form developed to aid in information gathering prior to calling physician.

Results: Reduced transfers, increased revenues and reduced inpatient mortality rate.

Reduced transfers to another facility by 28%
Average savings per transfer was $6210.
Reduced rolling six month inpatient med-surg mortality rate from 26/1000 admissions to 4 to 8/1000 admissions. This was a reduction in mortality by 70 to 85%.
[1/31/06]

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Santa Clara Valley Medical Center – San Jose, CA
Availability Status: Available to answer requests
Licensed Beds: 574
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: Carolyn Brown
Mentor Contact Email: Carolyn.brown@hhs.sccgov.org
Mentor Contact Phone: 408-885-2093

Additional Information:

• RRT is now an accepted and valued component in the management of care when a patient's condition is not stable and a nurse feels that additional support is needed. A team has been identified and expert responders are available at all hours of the day, 7 days a week.
• Staff and physician education have contributed to our success to date and we have seen that even physicians who do not have a designated role on the team often respond and volunteer their assistance whenever an RRT is paged.
• The interdisciplinary campaign team, led by a physician, responsible for development and implementation of the plan addressed concerns about availability of resources in collaboration with our executive steering committee and continue to be leading the evaluation and ongoing management of the intervention.  Feedback on effectiveness of the strategy has been extremely positive and the number of RRT calls is steadily increasing while codes outside the ICUs are decreasing. Active participation of physicians, nurses, respiratory therapists, and shift supervisors in creating the plan has built a solid foundation for accountability and ongoing success.
• At our organization-wide Patient Safety Fair, the RRT booth was one of the most popular and interesting and featured a professionally produced, team-created video reenacting an RRT response, a colorful and informative storyboard, giveaways promoting the Rapid Response Team, and opportunities to speak with team members.

• The percentage of Code Blues outside the ICUs has decreased from an average of 48% (range 35% to 60% in the 6 months prior to implementation) to 25% in the first 10 weeks of implementation.
• Total of 82 RRT calls during the first 10 weeks.
• 52% of patients who were seen by the RRT remained in in Med/Surg and did not require transfer to a higher level of care.
• RN satisfaction with RRT in all 10 categories ranged from 4.7 to 5 (on a 5 point scale, 5 being the highest level of satisfaction)
• Physician satisfaction in all 8 categories ranged from 4.7 to 5.

[4/28/06]

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Self Regional Healthcare – Greenwood, SC
Availability Status: Available to answer requests
Licensed Beds: 420
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: September 2005
Mentor Contact Name: John Paguntalan
Mentor Contact Email: jpaguntalan@selfregional.org
Mentor Contact Phone: 864-725-4926

Additional Information:

• Implemented RRT on 40 bed Telemetry Unit in September 2005
• Using IHI and NRCPR tracked results
• Moved pilot to Medical Floor in February 2006
• Presented implementation and results at SC Node Meeting in Feb 2006 to participants
• Asked by two small rural hospitals in our area to mentor in RR  based on preentation at SC Node meeting
• Teleconference presentation to listeners on NRCPR call in April 2006
• Selected as posterboard presenter for MET at national NRCPR conference in June 2006

% of Codes outside CC before RRT implementation  11%
After RRT implementation 5%
Decrease in codes outside CC  54%
[6/2/06]

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Sequoia Hospital – Redwood City, CA
Availability Status: Available to answer requests
Licensed Beds: 421
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: May 2004
Mentor Contact Name: Joanne Jeffords, VP, Mission and Quality
Mentor Contact Email: joanne.jeffords@chw.edu
Mentor Contact Phone: 650-367-5855

Additional Information:

lmplementation came from sharing the Australian MET results with our medical staff and educating nursing staff through 1:1 by the Rapid Response Team leads. The concept was welcomed based on our prior year's success with the ICU collaborative. During initial implementation, team leads actively rounded on units to help nursing staff identify potential Rapid Response Team patients. Early on, we addressed physician and staff concerns about implementation.

Our continued success has come from:
• Daily contacts between staff and Rapid Response Team members
• Providing timely follow up to staff who utilize Rapid Response Team
• All calls are handled as important.  We never allow criticism, only learning and support.
• Post our ongoing measures on the units.
• Interdisciplinary team reviews all calls to identify possible areas for improvement. For example, we identified and implemented a standardized approach to unit placement of patients requiring BI PAP.

For the first 130 cases (5/2004 - 12/2005) the results are as follows:
50% of cases stabilized on the unit and did not require transfer to higher level of care
52% of calls required less than 15 minutes of the Rapid Response Team presence and support.
Of 130 cases, only 2 cases reviewed were believed to be "inappropriate" – staff was encouraged in both cases to use the Rapid Response Team again.
Goal:  Decrease codes in lowest level care units; approximately 30% drop in codes on the medical-surgical unit.
56% of cases have come from day shift (0700 - 1900)
Average 7 - 9 calls month; target is 15
Overall non risk adjusted mortality has shown a positive decline from 2.06% (1st Q CY 2004) to 1.50% (4th Q CY 2005)

[2/28/06]

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Southern Ohio Medical Center – Portsmouth, OH
Availability Status: Available to answer requests
Licensed Beds: 421
Teaching / Non-Teaching Status: Teaching
Setting: Rural
Start Date of Intervention Work: September 2005
Mentor Contact Name: Mark Hammons – ICU or Becky Hall – Performance Improvement
Mentor Contact Email: hammonsm@somc.org; hallbe@somc.org
Mentor Contact Phone: Hall 740-356-8573

Additional Information:

• The Rapid Response Team concept was received very well by the staff.  Positive support by Administration for the Rapid Response Team concept.
• Education on the Rapid Resonse Team purpose, goals, etc. was completed in the month prior to the team start-up.
• Medical Staff was educated on the Rapid Response Team prior to the start date.  Medical Staff continues to receive data on the team progress.  Positive support by the Medical Staff.
• Thank you cards were sent to all members involved in the Rapid Response Team calls.
• Calls to the Rapid Response have continued to increase one year into the inception.
• Evaluations on the Rapid Response Team by the staff continue to be positive.
• One year Rapid Resonse Team celebration was held for all staff.

• Reduction in the percentage of patients who need transer to a higher level of care.
• Code Blue rates outside the ICU are down to 1 per 1,000 discharges.
• Codes per 1000 discharges have decreased from 4.26 to 1.16
• There has been a direct relationship to Rapid Response calls and codes outside of ICU:  When the RRT calls are low, the codes are high.
RRT calls have increased from a low of 10 calls/month to 32 calls in the most recent month.
• Utilization of the RRT per 1000 discharges has increased from 13 to 27.
[3/13/07]

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Southwestern Vermont Medical Center – Bennington, VT
Availability Status: Available to answer requests
Licensed Beds: 99
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: September 2005
Mentor Contact Name: Mark Novotny, MD
Mentor Contact Email: mnn@phin.org
Mentor Contact Phone: (802) 447-5006

Additional Information:

• We feel we have had the "function" of rapid response teams built into our hospitalist program since inception in April 2002 when nursing and medical staff agreed that hospitalists could be called for any problem on any inpatient at any time. We only recently formalized the "rapid response" format.
• This is in a trial phase on Med/Surg. Nurses are very receptive to the concept. 
• Hospitalists were eager to be members of the team. They worked with the Safety Department and nursing to develop criteria for a Rapid Response call.
• Education was done for Med/Surg nurses, Respiratory Therapists and Hospitalists. Also occuring simulataneously was a mandatory program for all nurses: hand-off communication (SNAP).a piece of that program is using SNAP in a Rapid Response situation.
• We plan to extend Rapid Response Team to Women's and Children's Service, Radiology, and ACC by March 2006. Rapid Response team numbers are reported out at PI committee.
• Staff using the Rapid Response Team are given a survey to complete on the effectiveness of the team. Results will be evaluated.
• We will measure number of codes occuring outside of the ICU
• We will measure number of Rapid Response Team calls monthly
• We will review appropriateness of call and disposition of patient.
[2/14/06]

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Swedish Medical Center – Seattle, WA
Availability Status: Available to answer requests
Licensed Beds: 697
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2005
Mentor Contact Name: Theresa Bervell
Mentor Contact Email: theresa.bervell@swedish.org
Mentor Contact Phone: 206-386-6724

Additional Information:

The Rapid Response Team (RRT) has been strongly embraced at Swedish Medical Center, with high levels of satisfaction expressed by RRT members, staff contacting RRT, attending physicians, and even patients.

With three campuses (hospitals) comprising Swedish Medical Center, we have learned how to implement RRT in a variety of settings, large and small.

Swedish created a unique educational module for RRT geared toward RRT members which included differentiating between RRT and a "code" team, employing supportive communication techniques, and use of SBAR communication.

Inpatient Mortality at Swedish Medical Center decreased 6% in 2005.

At Swedish Medical Center's largest campus, where the team was implemented in January, codes decreased by more than 25% for the first nine months of 2005 when compared with the same time period in 2004.
[1/31/06]

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Tacoma General/Allenmore Hospital – Tacoma, WA
Availability Status: Available to answer requests
Licensed Beds: 521
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Tammi Lead
Mentor Contact Email: tammi.lead@multicare.org
Mentor Contact Phone: 253-403-2889

Additional Information:

The Rapid Response improvement team developed order sets, documentation tools, and evaluation forms, which allowed staff to implement selected interventions while physician notification occurred along with recording staff perceptions of process.  Initial months of activity resulted in minor changes to the order set based on newly developed protocols and additions to the team based on staff input.  Communication process was also changed with a focus on consistency across the system to increase timely notification of the Rapid Response Team (RRT).

Education was expanded across the system to include support departments such as Social Work and Imaging.  Clinical staff collaborated with the Marketing Department to create a fact sheet for patients and families that has been placed in the waiting rooms of the clinical departments.  Future work will include developing a process for family activation of RRT along with placing educational information in all patient rooms.

Thirty-six Rapid Response Team (36) calls were initiated between October and December 2005.  Sixteen (16) patients transferred to a higher level of care, nineteen (19) stabilized, and one (1) deteriorated into a Code 4 (the occurred within the first two weeks of implementation).
 
The Code 4 occurrence rate has declined from 3.72 per 1000 discharges in 2004 to 2.46 per 1000 discharges in 2005 or improvement of nearly 34%.  In addition, a survey of the staff indicates high satisfaction with the Rapid Response Team process.
[3/30/06]

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Transylvania Community Hospital – Brevard, NC
Availability Status: Available to answer requests
Licensed Beds: 25
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: July 2005
Mentor Contact Name: Scotta L. Orr, RN, BSN, MPH, Director of Quality/Accreditation Services
Mentor Contact Email: sorr@tchospital.org
Mentor Contact Phone: 828-862-6383

Additional Information:

The Transylvania Community Hospital Rapid Response Team is comprised of a respiratory therapist and a critical care nurse on call 24 hours/7 days a week. The hospitalist and clinical nurse specialist also respond when they are in house. ED staff responds when a CCU nurse cannot leave the unit. Staff notification of a code occurs using both the overhead paging system and personal pagers.

Initial development and implementation of the Rapid Response Team occurred quickly. The team is in an ongoing process of development and education to maintain a high level of timely response, standards of care and positive outcomes. Standard protocols for intervention and documentation were developed and approved by the medical staff.

Transylvania Community Hospital’s team was initiated house-wide vs. using a test unit method due to our small size and number of beds.

Education was initially provided and is continually updated for staff in all areas of the hospital so the entire hospital can utilize the program, not just bedside nursing units. Special attention and education is provided to non-nursing personnel (i.e., radiology, MRI, registration) to call the Rapid Response Team in their specialty areas instead of waiting to send the patient back to their room.

• 100% of response time is less than 5 minutes

• Duration of calls range from 16 -30 minutes

• 78% reduction in code blue calls from 2004 to 2007

• 32% reduction in crude inpatient mortality rate since 2004

Patient Disposition:
• 22% transferred to tertiary referral hospital
• 11% no change in level of care
• 4% patients declined in status to full code
• 67% transferred to ICU
[2/8/08]

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UF & Shands Jacksonville – Jacksonville, FL
Availability Status: Available to answer requests
Staffed Beds: 538
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: Cynthia Gerdik RN, Director Trauma/Surgery/Rapid Response
Mentor Contact Email: cynthia.gerdik@jax.ufl.edu
Mentor Contact Phone: 904-244-8460

Additional Information:

Shands Jacksonville is a geographically divided campus, so it implemented two Rapid Response Teams each consisting of an experienced ICU RN and experienced Respiratory Therapist.  No FTE's were added, each ICU provided FTE's from their individual budgets for implementation of this patient safety initiative.

Our teams were designed  as critical care outreach programs, proactively assessing identified high risk patient populations via the ICU RN whose only assignment is Rapid Response Team. This RN rounds at least twice a shift on all nursing units proactively asking staff are they worried or concerned about any of their patients.
Units with more non-ICU codes are rounded on at least twice in 12 hours. The relationship that the staff have built with our Rapid Response Team RNs has also been critical to our success.  We even have clerks calling us now to alert the team that the physician is writing STAT orders on a patient. We believe our model is making a difference, taking the ICU to the med-surg bedside.

As part of critical care outreach each shift this RN assess all transfers from ICU's, all patients with trachs or halos on med-surg units, all patients receiving chemo, long term ventilated patients and all new admissions in our smaller annex building across street from main hospital.  We also respond to any visitor or employee injury or illness. In October of 2007, we phased in allowing family members to call for a rapid response and have found this to be a valuable adjunct to helping identify patients at risk for deteriortion. 

2006:  170 codes* 
2007:  144 codes

(Note:  Though we believe we had a slight decrease in the number of codes outside the ICUs, unfortunately we did not have a reliable system in place until October 2006 to ensure capture of code blue data for review.)

With about 170 Rapid Response Team calls a month on our campus, about 39% of them are the result of this dedicated ICU RN rounding on nursing units at least once in each 12 hour shift.

In the  past two years, with a progressive phased implementaion, the mortality rate has decreased from 32.8/1000 discharges to 28.11/1000 discharges (VHA benchmark is 22.2/1000). Our med-surg survival to discharge after a resuscitation has improved from 21.5% of our Code Blues in 2006 to an average of 35.8% of our Code Blues in 2007. The team proactively rounds on approximately 35-40 patients each shift and receives 1 to 2 calls activated by family members per month.

[5/1/08]

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UHHS Richmond Heights Hospital – Richmond Heights, OH
Availability Status: Available to answer requests
Licensed Beds: 225
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: April 2005
Mentor Contact Name: Sharon Garretson RN, Manager of ICU & Step-Down Unit or Mary Beth Rauzi, Manager of Learning Services
Mentor Contact Email: sharon.garretson@uhhs.com or mary.rauzi@uhhs.com
Mentor Contact Phone: 440-585-6156 or 440-585-6140

Additional Information:

At UHHS - Richmond Heights Hospital we have enjoyed much success with our Rapid Response Team (RRT) and we believe that this success is a direct result of several key measures:
• Received the full backing of the administrative team and medical staff to progress with a RRT
• Followed up with intensive education of every nursing and respiratory therapy staff member in the hospital.
• Stressed the importance of collaboration, teamwork, education and the non-punitive nature of the program.

At Richmond Heights Hospital, one of the initial concerns expressed by the ICU nurses in response to hearing about the concept of the Rapid Response Team was the potential for them to be taken away from their own patients in order to help care for other patients in the hospital. To respond to this concern, we agreed to monitor for about 6-8 weeks the number of times an ICU nurse was called to attend a Rapid Response Team call and the time spent out of the unit. Management agreed to reevaluate the current method of responding to the calls if it was determined that the ICU staff were being called out excessively.  It was also explained to the staff that the RRT call may actually save time in the long run, i.e., “Go for 15 minutes now or in six hours we can spend two hours resuscitating the patient.” In the 12 months that the RRT has been operating at UHHS Richmond Heights Hospital, there has not been a need to reevaluate this process. All staff appreciate the value that this team has added and they would not want to be without it.

Since implementation, our nurses feel more supported, more autonomous and most importantly our patients and their families are benefiting from a higher standard of safe and proactive care.  In addition, we have built on our success by assisting other hospitals within our system (from critical access hospitals to a large academic medical center) to develop their Rapid Response Teams.

As we approach our one year anniversary of the RRT implementation, early results are very encouraging. Our most impressive data encompasses the following:

• 100% education of nursing staff (RN & LPN) and Respiratory Therapists
• 51.5% decrease in cardiac arrests
• 64.4% decrease in cardiac arrests occurring outside the ICU
• 32% decrease in overall hospital mortality
• 44% decrease in cardiac arrests per 1,000 discharges
• 0 FTE's added to achieve these results

[1/31/06]

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United Health Services Hospitals - Binghamton General Hospital/Wilson Regional Medical Center – Johnson City, NY
Availability Status: Available to answer requests
Licensed Beds: 493
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: July 2005
Mentor Contact Name: Rosemary Ciotoli
Mentor Contact Email: rosemary_ciotoli@uhs.org
Mentor Contact Phone: (607) 762-2121

Additional Information:

Team members include Senior Resident, Critical Care Nurse, Respiratory Therapist and Nurse Leader (Nurse manager or Supervisor).  No additional FTEs were required.

Documentation tools used:
SBAR (for nurse to team report and nurse to MD report)
RRT Progress record
RRT Physician order form (preprinted orders of key interventions)
Debriefing Form (to be used after every event)

We also use posters and a power point presentation for education.  We are developing educational brochures to educate families on the RRT, but have not yet rolled out.

First 6 months of implementation:  decrease in inpatient CPR calls outside the ICU setting by 40%.
2x2 IHI matrix of mortality chart reviews:  lower right quadrant (non comfort care, no ICU adm) moved from 36% pre RRT to 14.3% post implementation.
[6/2/06]

*                *                  *

University Health Services, Inc. – Augusta, GA
Availability Status: Available to answer requests
Licensed Beds: 551
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: February 2005
Mentor Contact Name: Peggy Evans, PI Coordinator
Mentor Contact Email: p_evans@uh.org
Mentor Contact Phone: 706-774-2698

Additional Information:

After reviewing our current response systems in place and what, if any, data was being monitored, we began to plan for our Rapid Response Team (named MET - Medical Emergency Team) in 10/04. Our intent is to improve patient outcomes by earlier recognition of a patient's deteriorating condition and improved communication between caregivers.  With the endorsement of our Medical Executive Committee, the MET was implemented in 2/05. A data collection tool was developed to collect information regarding the event to facilitate more effective communication with the physician. The form would be forwarded to the PI Department for entry into a database. This form is now a permanent part of the patient's record.
Our team was initially comprised of the Administrative Nursing Supervisor, Resource Nurse Coordinator and Lead Respiratory Therapist. The need for the IV Team nurse was identified and that position was added to the MET.
There was also a need identified early on for further education of the nursing staff to assist with improving their critical thinking skills. Mandatory staff education was provided with regards to s/sx of sepsis, fluid balance and respiratory distress.

After an initial 24 calls the first month the MET was implemented, the average now is 44 calls per month, with the greatest increase noted after the mandatory education was provided in 06/05.
The average response time when a MET is called is 2.3 minutes, with the average elapsed time for an event at 32.5 minutes.
[1/31/06]

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University of Kansas Hospital – Kansas City, KS
Availability Status: Available to answer requests
Staffed Beds: 508
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: February 2005
Mentor Contact Name: Carol Cleek
Mentor Contact Email: ccleek@kumc.edu
Mentor Contact Phone: (913) 588-5696

Additional Information:

Implementing Rapid Response Teams has proven to be difficult for many teaching hospitals.  Fortunately, the University of Kansas Hospital has not been such a hospital.  Led by a cross-functional team (physicians, nurses and ancillary staff) and supported by a strong leadership team, Rapid Response Teams were implemented two months after the 100,000 Lives initiative was introduced.  The Rapid Response Team has been utilized for patients in all medical services and by every unit in the hospital.  In addition, even with the arrival of new residents in the fall, the utilization rate of Rapid Response Teams has remained consistent, indicating an acceptance of this important resource by the physician community.  The success of the initiative was facilitated through strong planning, effective, multi-dimensional communication and continuous measurement and improvement.

Rapid Response Teams have been implemented with no additional FTE's.  The team consists of a seasoned Critical Care Nurse and a seasoned Respiratory Therapist.  A Critical Care Physician is available to the team should the need arise. 

The quantitative impacts of the Rapid Response Teams on patient outcomes have been very positive. 

* Activations have increased from approximately 21 per month for the first six months of the initiative to 72 per month for the most recent six months.  All services and all units have activated rapid response teams since their inception.  The most freqent trigger for the RRTs has been "worried about the patient" (14.66%). 
* Less than 50% of the activations have resulted in the patient needing to be transferred to a higher level of care. 
* The ultimate measure of success has been the survival rate for patients experiencing and RRT.  Since the inception, 82% of RRT patients have survived to discharge.  For the most recent month, the survival rate has climbed to 85%.  ---Similarly, the number of codes outside the ICU/1000 discharges has declined from 6.11 prior to the initiative to 2.53 for the most recent six months.  And, the percent of codes outside the ICU has declined from 44% prior to implementation of RRTs to 22% during the most recent reporting period.
[3/20/08]

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University Medical Center – Tucson, AZ
[Adult & Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 365
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2005
Mentor Contact Name: Deborah Pesicka, Quality Specialist
Mentor Contact Email: dpesicka@umcaz.edu
Mentor Contact Phone: 520-694-4062

Additional Information:

UMC has taken a unique approach to the Rapid Response Team (RRT) concept.  Some services expressed a reluctance to have RRT members from other services responding to their patients at risk. Out of necessity, we developed four (4) RRTs: Medical, Surgical, Cardiothoracic, and Pediatric. Each ICU is partnered with floors to which their patients are most likely transferred. Each team consists of the ICU Charge RN and the Charge Respiratory Care Practitioner, with MD back-up. The requesting unit calls a designated RRT number to connect to the teleoperators who in turn page the appropriate RRT. The requesting unit also pages the attending team including a Rapid Response Team code in the message. The patient's RN initiates an RRT report form which includes a SBAR section, s/he then stays at the bedside and assists the RRT. The RRT responders then stabilize the patient and complete the RRT report form. If a transfer of location is necessary, the RRT responders facilitate the transfer. Although the multi-tiered RRT unavoidably increases complexity, our unique system has been very successful thus far and has allowed a specialized RRT to aid patients in urgent need. As an added benefit, harmony between services is maintained in our busy academic medical center and the primary goal of providing optimal patient care is achieved.

We average 10-15 RRT activations monthly. Greater than 50% of the time the RRT arrives within 5 minutes of the activation. Although we've not seen an on-going change in Codes-outside-the-ICU, attempting to capture this number has made us aware of inconsistencies for reporting Codes within the hospital. Once we improve that process, we anticipate that there will be a fall in codes-outside-the-ICU.
[5/12/06]

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University of Iowa Healthcare – Iowa City, IA
Availability Status: Available to answer requests
Licensed Beds: 762
Teaching / Non-Teaching Status: Teaching
Setting: Rural
Start Date of Intervention Work: July 2005
Mentor Contact Name: Sheri Swartzendruber
Mentor Contact Email: sheri-swartzendruber@uiowa.edu
Mentor Contact Phone: 319-356-8127

Additional Information:

Since July 1, 2005, any care provider can call the Rapid Response Team when concerned about a clincially unstable adult patient.  Staff have been educated regarding the criteria for calling the RRT (Dial 199).  Posters and pocket cards keep this criteria in sight. The team consists of a senior medicine (or surgery) resident, an intensive and specialty services nursing supervisor and the respiratory care supervisor.  To provide critical patient care support, they assess, stabilize, assist with communication, educate and assist with transfer, if necessary.  Key effectiveness measures include the number of RRT calls, in-hospital deaths/discharge and codes outside the ICU.

There have been 88 RRT deployments from July-December 2005. 
60% of the patients were transferred to ICU
8% had subsequent cardiopulmonary arrest
81% of the patients were discharged alive
39% decrease in the number of patient codes outside of ICU.
[3/30/06]

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The University of Texas M. D. Anderson Cancer Center – Houston, TX
Availability Status: Available to answer requests
Licensed Beds: 465
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2005
Mentor Contact Name: Judith Gerst
Mentor Contact Email: jpgerst@mdanderson.org
Mentor Contact Phone: 713-792-8890

Additional Information:

In its first 10 months of operation, M. D. Anderson’s Medical Emergency Rapid Intervention Team – called MERIT – responded to more than 600 calls to inpatient units and medical emergencies in the hospital. Preventable inpatient cardiac arrests outside the Intensive Care Unit (ICU) dropped by 67 percent – far exceeding the team’s goal of a 20 percent reduction.

MERIT, which began operating in the Main Building on Jan. 3, 2005, comprises 20 senior critical care nurses from the ICU who are assigned to the rapid response team on a rotating basis as their primary nursing assignment for the shift. In addition to critical care experience, MERIT nurses obtain additional training in advanced life support and critical care transportation. The MERIT medical director, in conjunction with a patient’s primary physicians, provides physician oversight.

MERIT members are scheduled to respond to calls for support from inpatient floor staff when a patient demonstrates signs of deterioration.

During its first 10 months of operation, MERIT responded to the majority of calls based on nurse judgment, and respiratory or heart rate changes. Team members also visit every patient who has left the ICU within 12 hours to ensure there are no changes in that person’s condition.

• More that 600 Rapid Response Team calls in 10 months
• 67% Reduction in arrests outside the ICU
• Reduction in the percentage of patients who need to be transferred to a higher level of care

[5/12/06]

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Virginia Mason Medical Center – Seattle, WA
Availability Status: Available to answer requests
Licensed Beds: 270
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: July 2004
Mentor Contact Name: Michael Westley, MD
Mentor Contact Email: CIDMEDW@vmmc.org
Mentor Contact Phone: 206-625-7373  X 62525

Additional Information:
Our RRT is called MET (medical emergency team) and includes a hospitalist, Critical Care nurse and respiratory therapy, triggered by acute status changes or a worried clinician

VMMC averages about 70 calls monthly and have virtually eliminated potentially preventable CPR codes outside the CCU.
[2/14/06]

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White County Medical Center – Searcy, AR
Availability Status: Available to answer requests
Staffed Beds: 186
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: January 2006
Mentor Contact Name: Peggy Turner or Cyanne Hamill
Mentor Contact Email: pturner@wcmc.org or chamill@wcmc.org
Mentor Contact Phone: 501-380-3480 or 501-380-2281

Additional Information:

The White County Medical Center Rapid Response team consists of the House Nursing Supervisor, Critical Care Nurse and a Respiratory Therapist. No additional FTE's were added.

Reasons for success:

Embraced by the nursing staff. New staff had the reassurance that they could have help and teaching from peers. Great for recruitment of staff. Overwhelmed staff had a resource to call for help. Cooperativeness between nursing and Respiratory Therapy was enhanced.

Our persuasive champions were the House Nursing Supervisors. They initiated many of the calls and prompted other nurses to do so.

Staff physicians were fully behind this practice being initiated. They felt like they were being given good solid information when they were called and that we were really on top of patients' condition changes.

Immediate positive results were seen with this initiative. The number of codes went down. CCU transfers decreased. Staff embraced the practice. Patients were well cared for.

Continual teaching about the Rapid Response Team keeps it in the forefront of staff's minds. About every three months, we repeat some form of education to keep the practice fresh in everyone's minds.

We share our success stories monthly at the leadership meetings and information is then communicated to the staff level.  Information is shared at medical staff meetings as well. We collect data and share this on a monthly basis with our other patient safety indicators.

We started this housewide right away. We had very few skeptics.  We planned well. Involved all the right people.  Educated, listened to feed back and rapidly implemented.  This was by far one of our most successful projects and easiest to implement. We had various pilot versions of the documentation tool until we finalized it.

25% reduction in codes outside of CCU & ER since inception January 2005.  Reduction in codes from 0.6/1000 patient days in 2005 to 0.45/1000 patient days in 2007.

Rapid Response Team calls increased 32% from 2006 to 2007.

Hospital-wide mortality rate has decreased 11.5% since Rapid Response Team began.   

Overall decrease in patients needing to be transferred to a higher level of care.
[4/03/08]

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Winter Haven Hospital – Winter Haven, FL
Availability Status: Available to answer requests
Staffed Beds: 360
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: Cynthia Ritter, Administrative Supervisor
Mentor Contact Email: cynthia.ritter@mfms.com
Mentor Contact Phone: 863-293-1121, Ext: 4292 or Pager # 1235

Additional Information:

Winter Haven Hospital in Florida began our Rapid Response Team in January 2006. During the first year, we were disappointed that we did not see the expected reduction in non-ICU codes. We attributed the lack of change to the way in which we defined “Code Blue” (any time a Code Blue form is filled out) or to our increasing level of severity (we started cardiovascular surgery in January 2006). Observation of our increasing use of Rapid Response and reports indicating its effectiveness in catching changes early seemed to contradict our data.

We persisted in using Rapid Response and extended it to patients and families believing that it was “the right thing to do.”  Then, the change happened.  As we looked at 3 quarters of data for our second year (2007), we began to see a decline in non-ICU codes and our hospital mortality rate. When we summarized our second year, we were certain that the trend was real.

We believe that we needed two years to show the expected outcome because Rapid Response Teams are really a culture change; a change in the “why, when and how” nurses work together.  It took time to convince some people that consulting other nurses to assist with assessment and communication did not diminish their own skills as nurses.

We are currently implementing an order protocol to be used by the team that will include many of the emergency treatments we have found useful in our 2 years of experience.

A comparison between 2006 and 2007 Rapid Response utilization indicates a 100% increase in calls for assistance (95 calls in 2006; 191 calls in 2007).  Records indicate a 10% decrease in "Out of ICU" Codes and a 9% increase in survival of "Out of ICU" codes.

Non-ICU Code Rates (calculated using discharges as the denominator)

Non-ICU Code Rate      % Reduction
CY-2005 4.61  
CY-2006 5.10               11% increase
CY-2007 4.57               1% reduction over 2005 and a 10% reduction over 2006

[10/24/08]

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Yale-New Haven Hospital – New Haven, CT
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 144 pediatric beds
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2005
Mentor Contact Name: Andrea Benin
Mentor Contact Email: andrea.benin@ynhh.org
Mentor Contact Phone: 203-688-8692

Additional Information:

Yale-New Haven Hospital has been successful in implementing rapid response teams for Pediatrics by instituting a team based out of the ICU that is available 24 hours per day, 7 days per week.  This team has been very favorably received by the medical and nursing staff.  As of January 2006, we are implementing an equivalent program for the adult-care services.

Thus far, we have analyzed pilot data comparing the first 6 months of implementation of the pediatric rapid response team (RRT) to the same 6 months of the year prior.  We have found that there was a notable decline of 39% in the number of hours between the time patients first demonstrated a possible indication for transfer to the pediatric intensive care unit (PICU) and their time of transfer to the PICU.  We are currently implementing monthly evaluation of a set of metrics that includes the time between patients' first indication that they might need care in the PICU and transfer, time elapsed between call for and arrival of the RRT, proportion of patients progressing to full-codes before transfer, the number of codes per 1000 discharges, the proportion of in-hospital codes that occur outside the PICU, and the number of calls to the RRT per month.
[8/4/06]