ArticleImplementing a rapid-response team using a nurse-to-nurse consult approach
Section snippets
Background
In December of 2004, the initiative for the 100,000 Lives Campaign was launched by the IHI to reduce hospital mortality and morbidity.4 This initiative recommended that acute care facilities implement best practices, including improvement in patient care for acute myocardial infarction; prevention of adverse drug events, central line infections, surgical site infections, and ventilator-associated pneumonia; and deployment of rapid response teams. The goal of the initiative was to save 100,000
Development and implementation
On the basis of the evidence and positive outcomes reported by the IHI, Ochsner Medical Center decided to support the implementation of a hospital-based MET. A steering committee was established consisting of nursing leadership, nursing education, physicians, respiratory therapy, and performance improvement. Administrative support was essential for the success of this initiative. Physician leadership representing a variety of services (critical care, medicine, neurology) was included to
Findings
After the first year of implementation, results demonstrated positive trends in improving clinical outcomes. Overall mortality decreased from 2.35% (2005) to 2.13% (2006); t tests were not calculated. Figure 3 illustrates the impact of CORE team calls on the total number of code blue events. A total of 231 team activations were completed during 2006 with 57 code blue events occurring outside of ICU areas. Although monthly results varied, there was a trend suggesting that as CORE calls
Conclusions
The findings from this performance improvement project are similar to those from other published studies.6, 7, 8, 9, 10 The findings support that METs decrease mortality and that the primary reason for team activation is nurses' concerns about the patient. Although the literature reflects that most METs include a physician, our team is unique in that a nurse and respiratory therapist complete the initial evaluation. In many instances the patient is managed without direct physician intervention;
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Cited by (34)
European Resuscitation Council Guidelines for Resuscitation 2015. Section 3. Adult advanced life support.
2015, ResuscitationCitation Excerpt :Post hoc analysis of the MERIT study showed there was a decrease in cardiac arrest and unexpected mortality rate with increased activation of the MET system.136 The evidence from predominantly single centre observational studies is inconclusive, with some studies showing reduced numbers of cardiac arrests after MET/RRT implementation38,41,123,137–159 and some studies failing to show a reduction121,122,124,125,160–163. However, systematic reviews, meta-analyses and multicentre studies do suggest that RRT/MET systems reduce rates of cardiopulmonary arrest and lower hospital mortality rates.164–166
Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review
2013, ResuscitationCitation Excerpt :In the USA (Table 8), much of the impetus to develop rapid response teams (RRT) has come from the “100,000 lives campaign” publicised by the Institute of Health Improvement (IHI).68 Supported by the IHI, numerous centres56–58,60,62,64 published similar positive findings following implementation of response teams. However all these studies while enthusiastically embracing the concept of the RRTs, have a lack of clarity on basic study methodology and demographic information.
The impact of medical emergency teams on ICU admission rates, cardiopulmonary arrests and mortality in a regional hospital
2011, ResuscitationCitation Excerpt :Despite improvements in technology and training, only 32% of patients survive an in-hospital cardiac arrest.1 The majority of these arrests are preceded by observable indicators of deterioration within hours of the event.2 In response, rapid response systems (RRSs), also known as medical emergency teams (METs) have emerged, providing a team of clinicians with expertise in critical care to provide early intervention to at risk patients.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support
2010, ResuscitationCitation Excerpt :The available studies do not correct for these confounding factors. Nevertheless, numerous single centre studies have reported reduced numbers of cardiac arrests after the implementation of RRT/MET systems.45,47,107,111,113–125 However, a well-designed, cluster-randomised controlled trial of the MET system (MERIT study) involving 23 hospitals24 did not show a reduction in cardiac arrest rate after introduction of a MET when analyzed on an intention-to-treat basis.
Rapid response system restructure: Focus on prevention and early intervention
2021, Critical Care Nursing Quarterly