November 2005 Volume 29 No.10
Rapid Response Team starts operating in November

The Stanford Hospital and Clinics (SHC) Rapid Response Team (RRT) will begin operating in November following the approval of the SHC administrative policy for the RRT by the SHC Medical Board in November.

The implementation of RRTs in US hospitals is a patient safety initiative of the Institute of Healthcare Improvement’s 100,000 Lives Campaign. SHC has been planning for its RRT for six months.

The SHC RRT can be activated by nurses, physicians, respiratory therapists, nurse practitioners, or physician assistants who provide patient care at Stanford Hospital. RRT activation does not require a physician’s order or permission.

  • The policy calls for an RRT to be summoned when:
    • A patient has an acute change in condition.
    • The Primary Physician Team has been notified of the change.
    • The patient needs additional medical care.
  • Acute changes specifically include:
      • Systolic BP < 80 mm Hg
      • HR < 40 > 140 BPM
      • RR < 8 > 30 BPM
      • Oxygen saturation < 88% for more than 5 minutes
      • Urine output < 50 mL in 4 hours
      • Acute change in level of consciousness
      • Staff "worried" or "concerned" about patient

"When the RRT is activated, a concurrent call will always be placed to the patient’s Primary Physician Team", said Larry Shuer, chief of staff and the hospital’s sponsor of the patient safety initiative.

The SHC RRT consists of a critical care fellow, an ICU nurse, a critical care crisis nurse, and a respiratory therapist who will respond within about 10 minutes of being called.

"The RRT will work closely with the patient’s Primary Physician Team," noted Shuer. "When the patient’s Primary Physician Team is not immediately available, the RRT will treat urgent problems as indicated. When the Primary Physician Team is immediately available, the RRT will make recommendations for treatment but will defer to the Primary Physician Team for final decisions regarding treatment," Shuer explained.

Since RRTs are intended to treat hospitalized patients, SHC’s RRT will respond to inpatients, patients admitted for observation, and patients admitted to the Ambulatory Treatment Unit (ATU) for outpatient procedures. The RRT will not respond to patients in the Cancer Center, Boswell Clinics or the Blake-Wilbur building, the policy states.

"Our RRT will provide rapid treatment to prevent or stop hospital complications from occurring," said Ann Weinacker, assistant professor of medicine and the physician champion charged with implementing and evaluating this interdisciplinary patient safety initiative.

"Importantly, the presence of the RRT at a patient’s bedside should not be viewed as a sign of inadequate medical care. Rather, its presence should be perceived as a simple bedside consult that can help relieve a stressful situation for housestaff and nurses and ensure a patient’s safety," said Weinacker. A key responsibility of the critical care fellow on the RRT will be to involve and educate housestaff to recognize and treat complex hospital complications. "This is an important aspect of medical education today that will benefit housestaff at the same time it benefits patients," said Weinacker.

Shuer said the Quality Improvement and Patient Safety Department will be closely measuring the effects of the hospital’s RRT on patient and administrative outcomes and will share findings in future issues of Medical Staff Update.

U.S. hospitals implementing rapid response teams have grown from 50 in 2003 to about 1,400 in 2005. Clinical research evaluating the effect of implementing an RRT has demonstrated reductions in hospital mortality of inpatients and hospital length of stay, as well as significant reductions in the incidence of acute respiratory failure, severe sepsis, stroke and acute renal failure in hospitalized patients.