• Volume of cardiopulmonary arrests called outside the ICU by the end of 2006 or three months after implementation of a Rapid Response Team
• Reason for calling the Rapid Response Team, Rapid Response Team calls by the day of the week, Rapid Response Team calls by department
• The number of Rapid Response Team calls each hour
• Patient outcomes after a Rapid Response Team
• Discharge disposition after Rapid Response Team called

Salem Community Hospital is a licensed 200-bed hospital in northeastern Ohio that implemented a Rapid Response Team beginning in September 18, 2006. The administrative decision to implement a Rapid Response Team was based on literature identifying positive patient outcomes, safe quality patient care, and it was simply the right thing to do for the patients. A steering committee was organized to formulate a plan to:

• Review the evidence-based practice via literature review
• Determine who the team members would be by evaluating skills and services
• Establish criteria for how to call the Rapid Response Team
• Create documentation and data collection tools
• Develop policies, protocols, and standing orders for autonomous interventions
• Identify expected outcomes of the Rapid Response Team performance
• Determine a timeline and start date for implementation

Implementation of the Rapid Response Team at Salem Community Hospital exceeded our expectation in terms of reaching our goals. We were able to decrease the cardiopulmonary arrests outside the ICU by 38 percent, decrease the need for transfer to ICU by 6 percent, reduced the number of patient intubations by 44 percent, and increased our survival rate post cardiopulmonary arrest by 20 percent.

Aim: Decrease cardiopulmonary arrests outside the ICU by 25 percent

• Before Rapid Response Team: 16 non-ICU codes
• After Rapid Response Team: 6 non-ICU codes
• Result: 63 percent decrease

Aim: Decrease need for transfer to ICU*

• Before Rapid Response Team: 18 transfers to ICU
• After Rapid Response Team: 1 transfer to ICU
• Result: 94 percent decrease

[*Data collected was unscheduled returns to the ICU. Seventy percent of patients stayed on their units after Rapid Response Team and not transferred to a higher level of care.]

Aim: Reduce number of patient intubations

• Before Rapid Response Team: 43 patient intubations
• After Rapid Response Team: 19 patient intubations
• Result: 56 percent decrease

Aim: Increase survival rate post cardiopulmonary arrest

• Before Rapid Response Team: 9 survivors out of 25 codes (36 percent survival rate)
• After Rapid Response Team: 5 survivors out of 9 codes (56 percent survival rate)
• Result: 20 percent increase in survival rate post cardiopulmonary arrest

The success of the Rapid Response Team program was attributed to:

• Obtaining buy-in from nursing staff and physicians through planning, education, and communication
• Monitoring to continuously adjust and improve the Rapid Response Team performance

Satisfaction has been shown by staff, physicians and families.  Physician requests have expanded the Rapid Response Team program to include Medical Imaging and Ambulatory Care departments. Staff nurses have also requested to expand and include the pediatric patient population in the Rapid Response Team program.   

Cindy Wetzel, MSN, RN
Critical Care Clinical Nurse Specialist
Salem Community Hospital
wetzelc@salemhosp.com