Like thousands of other acute care hospitals in the US, the University of Kansas Medical Center (KUMC) joined IHI’s 18-month 100,000 Lives Campaign in 2005. Though KUMC implemented all six of the Campaign’s interventions, deploying a Rapid Response Team was the intervention that spurred the most innovation and long-term impact. In this interview, KUMC Vice President Terry Rusconi describes the multiple adaptations of the rapid response concept the organization has developed and the enduring value for patients and staff.
When and why did KUMC deploy its first Rapid Response Team?
We began planning for the implementation of Rapid Response Teams immediately after returning from IHI’s National Forum in 2004 launching the 100,000 Lives Campaign. We signed up to participate in all six Campaign interventions and focused first on how we would implement Rapid Response Teams, pulling together a team of physicians, nurses, and other staff to plan. By March 2005, we were ready to pilot our rapid response design on a selected number of hospital units. Surprisingly, the first call to the team did not come from a pilot unit so we quickly expanded our rapid response work to the entire facility.
We started this process because it just made sense for an organization committed to continuously improving the quality of care for patients. Failure to rescue was a problem and the Rapid Response Team intervention provided a tool for frontline staff to quickly obtain additional resources to assess, treat, and escalate care.
Do you currently have a “traditional” Rapid Response Team? Has the team evolved since you first implemented it?
We do have a traditional Rapid Response Team. The team comprises a critical care nurse and a respiratory therapist (RT). There is also a physician resource the team can contact, when needed. To activate the team, a staff person calls the switchboard and provides basic information, including location and the requestor’s name. In addition to the medical/surgical unit, the team has been called to assist in the outpatient clinics, hallways, sidewalks surrounding the building, and parking garages.
The structure and work of the team have pretty much stayed the same over the years. We made it easier for the team to chart in the electronic medical record, but the basic function and operation of the traditional team has remained the same.
What Rapid Response Team adaptations has your organization developed?
We added a number of other specialized response teams due to the success of the original initiative, including the following:
- Neonatal — To support specific needs in the NICU, this team has a pediatric critical care nurse and an RT experienced in the care of neonatal patients.
- STEMI — For patients suspected of having an ST-elevation myocardial infarction, this response team includes a cardiovascular nurse and a RT.
- Trauma and Burn — KUMC is an ASC Level One Trauma Center and an ABA-certified burn center for both adult and pediatric burn patients. These response teams include either members of the trauma team or burn team (including physicians) who are waiting when the patient arrives in the ED to assess and transport the patient to the next step in their treatment.
- Behavioral — Some patients and family members may have underlying psychological needs requiring additional support. This team comprises a mental health professional, nursing leader (nursing director or administrator on call), and security (if needed) who help diffuse situations in which a behavioral issue arises, negotiate behavioral contracts, and make any other needed interventions so care can be safely provided.
- Patient Safety — This team was most recently added and includes the nursing leader on call, risk management on call representative, and administrator on call who arrive within one hour of a “red” event (i.e., patient involved) to both support staff and begin the root cause analysis of the event. Using Lean principles, the team looks to understand how the event happened, if we can continue to provide safe care, or if we need to “stop the line.”
And here’s another more detailed example of one of the specialized response teams we created — the Acute Stroke Response Team (ASRT) — to illustrate both how the team operates and why it’s so important to have such teams in place, to quickly assess and get care to patients whose condition is deteriorating.
Mrs. P was a patient on our trauma/general surgery unit recovering from abdominal surgery. An active woman in her 70s and a former KUMC employee, she was feeling so good one day that she was walking laps around the unit. On one of those laps, however, her nurse noticed the patient listing to one side as she was walking. The nurse stopped to talk to her and recognized signs of stroke, including slurred speech and asymmetrical facial expressions.
Staff then called for the ASRT and moved the patient back to her room in a wheelchair. A neuro-trained RN, a neurology resident, and a team of medical students, arrived on the unit within 7 minutes. After evaluating the patient, they transferred her to radiology for a CT scan. Because she was recovering from surgery, the patient could not receive tissue plasminogen activator (tPA), and the decision was made to remove the clot using a catheter in interventional radiology.
The ASRT nurse coordinated activities between staff in both radiology departments, and stayed in regular contact with the patient’s attending vascular neurologist and daughter. It took just 24 minutes to remove the centimeter-long clot.
Within a months after the stroke, the patient was living independently at home and regained almost all functioning.
What results has your organization seen because of your use of Rapid Response Teams?
Almost immediately after launching the first Rapid Response Team, our gross mortality rates and risk-adjusted mortality index began to improve. We have seen nearly 10 years of sustained risk-adjusted mortality below expected rates. The number of code blues outside the ICU have declined to very low levels. Staff report on surveys that they feel supported and engaged in the process of caring for their patients.
What is it about the Rapid Response Team concept that has resonated for so many years with your clinicians?
We have built a culture of excellence at KUMC and this includes implementing best practices. We are also results driven and no one can argue with the results we have seen since the implementation of our first Rapid Response Team in 2005. Nurses feel empowered and supported in the care of their patients and our physicians are receptive to having additional resources to help diagnose, treat, and move patients to a higher level of care when needed.
We continue to find multiple ways to employ the rapid response model across our system, including expanding use of response teams in outlying facilities such as the Cancer Center with equally favorable results.
You may also be interested in:
The Rapid Response Teams resource page