Rapid Response Team Decreases Code Events and Unexpected Patient Deaths Outside the ICU

Rapid City Regional Hospital
Rapid City, South Dakota, USA



The team from Rapid City Regional Hospital was a participant in IHI's 5 Million Lives Campaign.


Angi Kiewel, RN, BSN, Assistant Director, Adult Intensive Care Unit

Angie Haugen, RRT, Clinical Quality and Development Supervisor, Respiratory Care



Decrease the number of unexpected deaths and codes outside of the intensive care unit (ICU) by 25 percent, by measuring box four (or box D) of the IHI Mortality Diagnostic Tool (also referred to as the 2x2 Mortality Matrix) after the first year of Rapid Response Team implementation.



  • Percent of codes outside of the ICU
  • Code blue patient percent survival at discharge
  • Patients admitted to floors outside ICU for active treatment who die unexpectedly during their hospital stay


After reviewing the recommendations outlined in the IHI 5 Million Lives Campaign intervention for establishing a Rapid Response Team, Rapid City Regional Hospital implemented a Rapid Response Team to improve patient care through early identification and intervention on behalf of patients experiencing medical emergencies. 

  • Developed a multidisciplinary performance improvement team (April 2005), utilizing a Plan-Do-Check-Act (PDCA) methodology
  • Identified criteria for calling a Rapid Response Team, a mechanism for notification of the team, level of intervention, physician notification, documentation tool, employee education and training, feedback mechanisms
  • Developed a policy/procedure
  • Provided frequent employee/physician education
  • Started pilot for Rapid Response Team (June 2005)
  • Deployed a team consisting of an intensive care nurse, respiratory therapist, hospital coordinator, and the patient’s nurse
  • Expanded services throughout the year to include: general medical/oncology, ortho/neuro surgical, progressive care units, Cancer Care Institute, outpatient services, admissions department, Rehabilitation Institute, pediatrics, and maternal/child unit, with the additional ability to call Rapid Response Team for deteriorating visitors, if needed
  • Implemented Condition “HELP” that enables patients and family members to activate the Rapid Response Team
  • Implemented a quality review of code blue and Rapid Response Team medical records to identify missed clinical triggers or any process concerns; areas identified as opportunities for improvement are reviewed with the ICU Physician Committee and department directors/supervisors for further follow-up when needed
  • Presented outcomes data to The Joint Commission (November 2008) 







Summary of Results / Lessons Learned / Next Steps

After deploying a Rapid Response Team and providing early interventions to a deteriorating patient, Rapid City Regional Hospital, a 417-bed regional medical center, has decreased the percent of codes occurring outside the ICU from 55 percent to 46 percent (see Table one, above) and has increased patient survival rate after a code event from 32 percent to 46 percent (see Table two, above) over three years. We have effectively decreased mortality as well. Table three above depicts the impact we have had on codes contributing to unexpected deaths and failure to rescue patients admitted outside of the ICU. Rapid City Regional Hospital has decreased unexpected deaths by 12 percent and decreased codes in that group by 38 percent from baseline to current data.


Lessons Learned:

  • Identify “champions” to help stay on course and be persistent with team support, data collection, and reporting findings to reinforce the acceptance of new initiatives
  • Provide continual physician and employee education and feedback
    • Initiated sending thank you cards to clinical areas for frequent reinforcement
    • Provided quarterly updates of outcomes data to administration, physicians, and hospital employees
    • Implemented overhead announcement for Rapid Response Team activation alerts to staff and “advertises” the availability of the service
  • Asked for feedback and suggestions from patients and families, bedside caregivers, physicians, and administration
    • Provided opportunities for feedback through employee forums, physician meetings, and post-event surveys
    • Shared information received, celebrate successes, and responded to concerns
    • Learned that caregivers had feelings of increased support at the bedside and reported increased opportunities for learning, especially with recent health care graduates
  • Addressed barriers early and consistently
    • Provided additional education to Rapid Response Team members to encourage positive communication and explained expected member characteristics
    • Changed Rapid Response Team notification from calling the hospital’s communications department on a general line with pager activation, to calling the hospital’s emergent response line, which includes an overhead announcement and pager activation in order to eliminate a delayed notification to the Rapid Response Team
    • Implemented a quality review of code blue and Rapid Response Team medical records to identify missed clinical triggers or any process concerns and addressed areas in need of improvement  
  • Shared experiences and lessons learned by submitting data for publication
    • The detailed instructions on the IHI.org Improvement Report template from the IHI made it easy to submit information
Next Steps:
  • Explore the addition of an automatic prompt in computerized documentation that will trigger employees to activate the Rapid Response Team based on a numbering/scoring system
  • Improve early identification of deterioration patients through hourly patient rounding
  • Increase involvement of individual unit management teams to enhance the review process and evaluate possible missed clinical triggers

Contact Information
Angi Kiewel, RN, BSN,
Assistant Director, Adult ICU
Rapid City Regional Hospital


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