Article
Implementing a rapid-response team using a nurse-to-nurse consult approach

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The majority of in-hospital cardiac arrests are preceded by observable indicators of deterioration within hours of the event. It is generally accepted that cardiac arrest occurs in response to cardiac arrhythmias, hypotension, and acute respiratory changes. Numerous research studies support that early recognition and prompt treatment of the early indicators of these conditions are associated with improved clinical outcomes and reduced mortality. National initiatives that support the use of emergency medical teams report significant improvement in mortality and morbidity. Health care quality initiatives, such as the 100,000 Lives Campaign and Preventing 5 Million Lives from Harm, advocate the use of rapid response teams in acute care facilities as a method to facilitate early recognition and management of patients at risk for cardiac arrest. One year after the implementation of a rapid response team at our academic tertiary care facility, the incidence of code blue events outside of the intensive care unit was reduced by 9% and overall mortality was reduced by 0.12%. This article will discuss the experience of developing, implementing, and evaluating outcomes associated with 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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