Rapid Response Teams

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A Rapid Response Team (RRT), also known as a Medical Emergency Team (MET) or Medical Response Team (MRT) is a team of clinicians who bring critical care expertise to the patient bedside. They are small but powerful teams designed to intervene with patients before they develop serious medical problems.

Early Intervention to Avoid Adverse Events

Life-threatening events such as cardiac arrest often have as much as six hours of warning time. An RRT brings experienced clinicians to the patient bedside to pro-actively address these warning signs rather than waiting for an event to occur and reacting to it.

The Team may be summoned at any time by any clinical staff member in the hospital to assist in the care of a patient who appears acutely ill, before the patient has a cardiac arrest or other adverse event.

Encouraging Results and Proposed JCAHO Patient Safety Goal

Rapid Response Teams are a fairly new concept in the US. These teams have been shown to reduce potential adverse events and save lives. Baptist-Memphis hospital in Tennessee was an early adopter of Rapid Response Teams in the US, beginning in 2003. They have seen a 28% drop in codes since implementing RRTâs at their facility, and a reduction of transfers to ICU from 82% to 46%. Due to these types of results, the use of RRT's are a proposed JCAHO Patient Safety Goal.

1 Benefits of a Rapid Response Team
2 Designing a Rapid Response Team
3 Obtaining physician buy-in
4 Educating nursing staff
5 When should the team be called?
- 5.1 "A bad feeling"
6 Who brings the supplies to the bedside?
7 Rapid Response Team protocols
8 Rapid Response Team forms

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Benefits of a Rapid Response Team

In a four-month period, implementing a Rapid Response Team at Austin Hospital/Melbourne University in Australia caused cardiac arrest deaths to drop from 37 to 16, ICU days after cardiac arrest dropped from 163 to 33, and inpatient deaths dropped from 302 to 222.
Baptist-Memphis hospital in Tennessee has seen a 28% drop in codes since implementing RRTâs at their facility. Nurses are getting better at noticing problems earlier; transfers to ICU after a Team consult have dropped from 82% to 46%.
McLeod Regional Medical Center saw a 34% decrease in the number of codes out on the nursing floors in the first year of implementation, and currently nearly 80% of patients who have experienced a Rapid Response Team consultation have been able to stay out on the nursing unit.
Nearly all hospitals find that the implementation of Rapid Response Teams leads to an increased sense of security for the nursing team, patients, and patients' families.

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Designing a Rapid Response Team

Making the decision to implement a Rapid Response Team is a major initiative for any hospital, but there are many available resources. Steps involved in Implementing a Rapid Response Team include:

Review Available Literature
Establish Team Goals
Choose a RRT Model
Identify Who Will Respond

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Obtaining physician buy-in

Physician Champions Invaluable
At a small hospital with an ADC of 41, the physician champion is a pulmonologist and the medical director for the ICU. He functions as a liaison between nursing and the medical executive committee and assisted the team in developing the MET protocols. Consequently the team initially received much better physician buy-in because another physician was presenting the information.

Standing Orders and Protocols
Hospitals without residents or other physicians on their Team may work from protocols and then contact the Attending Physician. Having a Physician champion involved allowed them to overcome the reluctance Attending physicians might express, as well as provided insight regarding where the team would encounter physician resistance. (Known colloquially as the âWhat do you mean youâve done this with my patient already?â factor.) The Physician Champion also helped with buy-in from the Medical Executive committee to institute these standing orders.

As a result of this Physician Champion, one small hospital has had excellent results with physician cooperation and buy-in. In fact, theyâve had an Attending Physician request that the RRT be called on behalf of one of his patients, which gave them proof of success in terms of Physician buy-in.

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Educating nursing staff

Once small hopsital's Team educated the floor nurses by having ED and ICU nurses guide them through the protocols, helping them understand why the Team made the decisions that they did, and coaching floor nurses to think critically. Educators found that the most powerful tool for educating floor nurses was the Case scenario, as it shows how powerful an RRT can be and also holds attention.

The MET nurses were coached to be very supportive of the floor nurses, to ensure that they never made them feel like the MET call was not necessary. They were taught that the most important reason for a MET call would be that the nurse "just didnât feel something was right", and it was acceptable for that feeling to be the sole reason for an MET call.

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When should the team be called?

Here are some examples of changes that should trigger a call to the Rapid Response Team:

Staff Member worried about patient
Acute change in heart rate
Acute change in systolic BP
Acute change in respiratory rate
Acute change in O2 saturation
Acute change in level of consciousness.

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"A bad feeling"

Note that the first trigger listed is an entirely subjective opinion regarding how the patient is doing. These feelings pay off; in many cases an uneasy feeling in an experienced clinician is the first sign of an impending critical patient event.

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Who brings the supplies to the bedside?

Obtaining the needed supplies for a Rapid Response Team call is often more of a challenge in larger hospitals. Smaller hospitals normally have less physical distance to travel for the supplies.

Smaller hospitals At smaller facilities, items are usually easier to access on the floors. One small hospital reports that the Respiratory Therapist already had a bag to bring when they were called stat anywhere in the hospital and they often take that bag to respond to a call.

Larger hospitals At larger hospitals, Team members might take a backpack that has basic equipment such as non-narcotic meds, lab drawing equipment, IV fluid, and other items that can be hard to find out on the floor.

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