Sheila Parker, RN, Associate Vice President of Nursing
Phil Scavotto, RN, Intensive Care Unit Nursing Director
Chris Hisrch, RT, Administrative Director of Pulmonary Medicine
Elizabeth Dermalian, RN, Clinical Staff Nurse, Intensive Care Unit
Kevin Crowley, Clinical Staff Respiratory Therapist
Marty Weatherhead, RN, Clinical Staff Nurse, Intensive Care Unit
Deb Jackson, RN, Clinical Staff Nurse, Intensive Care Unit

• Decrease the number of codes on medical-surgical floors by 50 percent
• Decrease the rate of patient returns (“bounce backs”) to the Intensive Care Unit by 30 percent
• Respond to Rapid Response Team request for services in less than 5 minutes

• Case mix index
• Patient days
• Number of codes on medical-surgical floors
• Percent of returns to the Intensive Care Unit
• Number of patients saved using 100,000 Lives Campaign “formula” provided in Don Berwick keynote speech (IHI National Forum, December 2004)
• Response time of Rapid Response Team

• Developed a decision making process to include key stakeholders
• Provided standard education template for staff and administrators to discuss the initiative to stakeholders: 4 weeks of communication and stakeholder sign off with chiefs, nursing staff, respiratory therapists, administrators

• Established one pager number for Rapid Response Team
• Differentiated between code team versus Rapid Response Team
• Monitored number of codes compared to before Rapid Response Team was activated
• Monitored impact on mortality rate
• Monitored returns to SCU (Intensive Care Unit)
• Correlated patient days to indicators we monitored
• Strengthened collegial relationships between medical-surgical nurses and Intensive Care Unit nurses.
• Added another layer of support for medical-surgical nurses, particularly new graduate nurses
• Initiated follow-up rounds on patients the Rapid Respond Team had responded to earlier in the shift
• Developed a standardized documentation process in patient's medical record

The results of the project demonstrate a 40 percent reduction of in-house codes on medical-surgical floors and over a 30 percent reduction in returns to the Intensive Care Unit.  The Rapid Response Team concept has had a positive impact on quality and patient flow.

• Ensure all staff understand the Rapid Response Team is not a code team
• The Rapid Response Team staff must be excellent communicators
• Rapid cycle change works. This initiative was implemented in less than 4 weeks from the time it was first discussed at the Medical Center.

• The Rapid Response Team concept can work well without a physician on the team in a large teaching hospital
• This is a unique teaching opportunity for nursing staff
• Provide outcome data frequently to stakeholders through graphs, email communications, postings
• Interview the staff on the medical-surgical units who made the calls to help evaluate the service
• Communicate the purpose of the initiative extensively (presentations, emails, screen savers) prior to the launch and every three months for the first year in order to embed the concept in the culture
• Stress to the medical-surgical nurses that they maintain responsibility for the patient
• Stress to stakeholders the nurses and respiratory therapists operate within the scope of their practice and the purpose of this initiative is primarily a nurse-to-nurse consultative role
• There were a total of 75 calls to Rapid Response Team during the initiative 
• We've seen early signs of positive impact on mortality

Sheila Parker
Associate Vice President of Nursing
Maine Medical Center
parkes@mmc.org

[Storyboard presentation at IHI's National Forum, December 2005]