Albert Einstein Medical Center
Philadelphia, Pennsylvania, USA
Carlos Urrea, MD, MS, Patient Safety Project Manager
Jeffrey Cohn, MD, Chief Quality Officer
Glenn Eiger, MD, Associate Chair and Program Director, Internal Medicine Residency
Mary Beth Kingston, RN, Chief Nurse Executive
Maureen Jordan, RT, Director of Respiratory Therapy
Stephen Heitner, MD, Chief Medical Resident
Jill Stunkard, RN, Clinical Director of Nursing
WATCH VIDEO CLIP
The Albert Einstein Medical Center team presents a posterboard of their improvement work at IHI's 2007 National Forum
The aim of the project was to reduce code-blue calls in non-monitored areas by 10 percent by the end of fiscal year 2007 (July 2006-June 2007) at Albert Einstein Medical Center
- Total number of code-blue calls (Emergency Department not included) per month
- Code-blue calls per 1,000 discharges per month
- Code-blue calls in non-monitored areas per month
- Number of calls to activate the Rapid Response Team per month
- Albert Einstein Medical Center joined the Academic Rapid Response Collaborative, a partnership between the Association of American Medical Colleges, University of Pittsburgh Medical Center, and the Delmarva Foundation in February 2006.
- Presented idea to medical staff and Process Improvement Council and obtained resources commitment for the creation of the team.
- Leadership group defined Rapid Response Team composition based on literature and other institutions’ experience. It was decided that a Chief Medical Resident, a Critical Care Nurse, and a Respiratory Therapist would compose the Albert Einstein Medical Center’s Rapid Response Team.
- Developed Rapid Response Team training program that focused on cooperation and teamwork for the members in a joint effort with Organizational Staff Development, Internal Medicine, Nursing, and Quality Management.
- Developed a simulation module to practice clinical and teamwork skills for the team.
- Created tent cards and business cards with how to and when to activate the Rapid Response Team information, and distributed the material throughout the hospital (including areas such as dialysis, GI suite, Echo lab, etc.).
- Rapid Response Team members visited the units to distribute the cards and create awareness of the new Rapid Response Team among staff.
- Rapid Response Team leadership attended the Nursing Network Councils to share the information and aim regarding the new team.
- Initiated a pilot from Monday to Friday, 8:00 AM to 5:00 PM.
- Compiled information about activation causes and staff satisfaction during the pilot phase.
- Analyzed the compiled information to better implement the full-time Rapid Response Team, and include the most common causes for activation as part of the curricula and training of new members.
- Patient Safety Manager rounded after every call during the pilot phase, conducting interviews with the activation team, to better understand the issues preceding the call.
- Deployed a 24/7 Rapid Response Team on March 2007.
Summary of Results / Lessons Learned / Next Steps
Implementation of a Rapid Response Team was a successful strategy to reduce the number of code-blue calls at Albert Einstein Medical Center. The mean number of codes — excluding those in the Emergency Department — was 40.8 per month for fiscal year 2006, while the mean number of code-blue calls per month was 20.25 for fiscal year 2007.
- Join a collaborative if possible. This provided valuable information on what others were doing and lessons learned from institutions ahead in the process.
- Involve Residency Program Directors early in the process. There was a concern that Rapid Response Teams would interfere with residents’ learning opportunities but this was not the case.
- Start small. The pilot phase allowed people to feel comfortable with the presence of the Rapid Response Team and helped to eliminate the fear that it would be over-utilized.
- Involve front-line staff in the decision making. The Critical Care Manager and Chief Resident attended the collaborative meetings and were directly involved in deciding the composition and functioning of the team.
- Include customer service tools for team member training. The motto was, “There is no such thing as an inappropriate Rapid Response Team call.”
- Encourage front-line staff to call, even if based on “gut feeling.”
- Round and discuss the calls with the front-line staff, letting them know that the call is important. This creates a sense of teamwork beyond the rapid responders.
- Assign an administrative person to accompany the Rapid Response Team during the first calls or the pilot phase. This helps identify and quickly resolve non-clinical issues that are encountered (communications, logistics, supplies, etc.).
Carlos Urrea, MD, MS
Patient Safety Project Manager
Albert Einstein Healthcare Network