Implementing a Rapid Response Team

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1 Identify Rapid Response Team Staff
2 Review Available Literature
3 Establish Team Goals
4 How can we spare the staff for the Team?

Identify Rapid Response Team Staff

What departments should be a part of a Rapid Response Teams? Generally, most facilities will minimally include an experienced ICU nurse and a Respiratory Therapist.

IHI recommends one of the following four models for RRTs:

ICU RN and Respiratory Therapist
ICU RN, RT, Intensivist, Resident
ICU RN, RT, Intensivist or Hospitalist
ICU RN, RT, Physician Assistant

You can view the Institute for Healthcare Improvement's opinion regarding the above models at the their website.

In practice, variations on Rapid Response Teams are often seen. Here are some examples of variations:

At Alta View Hospital in Sandy Utah, several individuals are notified of an RRT call, but the actual responders are Respiratory Therapist, ICU RN, Emergency Department RN, and Nursing Supervisor when available. The use of ED nurses is an extremely helpful configuration for smaller hospitals.
At LDS Hospital, they have a MD (Medical Resident), respiratory therapist, ICU RN, and Nursing Supervisor. They are currently considering whether they will continue to need an MD on the Team, and this is an issue every facility needs to consider.
At Stanford University, they use an ICU RN, Critical Care Crisis RN, Respiratory Therapist, and a Critical Care Fellow (Physician)

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Review Available Literature

The websites of the following organizations are good sources for RRT information:

Australia Dept of Human Services
JCAHO
The Lancet
AHRQ
Institute for Healthcare Improvement

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Establish Team Goals

Some of the Team goals hospitals have set for RRT's include:

To identify and prevent failure to rescue and start initiating interventions in the approximately 6-hr window in which a patient begins to deteriorate
To address floor to ICU admission delays
To help eliminate short ICU stays, a subgroup of patients that had an ICU LOS of about 6 hours, receiving specific interventions that allowed them to go back to the floor
To reduce transfers to ICUs

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How can we spare the staff for the Team?

One of the first concrete decisions that must be made when designing a Rapid Response Team is deciding how to obtain the staff for the team. Options include hiring additional staff, seeking additional funding, assigning nurses with no patient load, or simply making no adjustment to the patient load of the nurses.

This is a critical issue, and may be a "deal breaker" for some hospitals, as was the case at Alta View Hospital in Sandy, Utah. As they researched, they found that traditionally the literature suggests that the team be staffed with ICU nurses. However, Alta View had only 2 ICU nurses that often couldn't’t be spared from the ICU for a long period of time. They decided they would also draw from their ED Nursing staff, although the ED nurses also could rarely be spared.

They resolved that they could use existing ED and ICU nursing staff if they were very creative and flexible, largely basing this resolution on the idea that since they had been able to maintain a code team in the past, they could do so with an RRT. As Ruth Kleckner, Educator said, "It needed to happen and because it needed to happen they would find a way to make it happen."