Legacy’s Rapid Response Teams help prevent crises for critically ill patients
By Maileen Hamto, Communications Writer, CareOregon
By Maileen Hamto, Communications Writer, CareOregon
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When a patient’s condition begins to decline, immediate intervention is often necessary to help avoid a crisis. Hospitals at Legacy Health System are implementing a team approach to providing immediate care for patients through its Rapid Response Team program.
The team, comprised of a group of critical care experts, is available to rush to the bedside of a declining patient, assess the situation and make appropriate interventions. Focusing on patients with heart and lung conditions or those recovering from surgery, the program seeks to prevent codes and other medical crises from happening in the first place.
“The Rapid Response Team has been a great asset to physicians who cannot always be on site or are tied up with another patient at the time. Additionally, they are often more effective than just a physician because they can quickly administer necessary medications, fluids or respiratory treatments,” said Gordon E. Johnson, M.D., F.A.C.P., site director at the Legacy Mount Hood Medical Center Hospitalist Service.
Legacy’s Rapid Response Team program is funded by a grant from CareOregon’s Care Support and System Innovation Program, and is part of the 100,000 Lives Campaign responsible for saving a collective 122,300 lives nationwide. Success stories about the Rapid Response Team’s interventions are plentiful, especially at Good Samaritan Hospital, which served as the pilot site for the innovative program. Dr. Edward Solis, a medical resident at the hospital, recalls the case of a female patient, 64, who had bariatric surgery for morbid obesity.
“She experienced respiratory distress after bariatric surgery. The patient also had chronic pain syndrome,” he said. The nurse alerted the Rapid Response Team, which hurried to the bedside to provide the necessary interventions. “We found that the patient was reacting to her pain medication. To quickly stabilize her condition, we gave her Narcan, a drug that works to reverse the effects of narcotics.”
If the team had not been available to respond immediately, the patient’s condition would have worsened. In many cases, the adverse effects of narcotics offers a very slim time frame for proper intervention, said Cindy Lilley, nurse manager. The patient was eventually transferred to the intensive care unit for observation.
Another success story involves a gynecology surgery patient who complained of chest pressure. “It was problematic because chest pressure typically doesn’t develop after this kind of surgery,” said Julie Howe, respiratory care practitioner, who was part of the responding team.
The physician who performed the surgery was not immediately available. The nurse alerted the Rapid Response Team, and the patient quickly received the care she needed before the problem became life-threatening.
The collaborative nature of the Rapid Response Team empowers its members to take action – within their scope of practice – to stabilize a patient. The patient's attending physician is notified of the team's assessment, and patients are transferred to the ICU when appropriate. The team is not intended to take over for the patient’s doctor or the bedside nurse, stresses Linda Jones, RN, Manager of Clinical Practice Support and Rapid Response Team project coordinator.
“The team concept is based on the Institute for Healthcare Improvement’s theory that it is best to rescue patients early in their decline, before a crisis occurs,” she said. “Hospitals across the nation using a Rapid Response Team report reductions in cardiac arrests, unplanned transfers to the ICU and overall mortality rates.”
Rapid Response Teams currently are in place at four Legacy hospitals – Legacy Good Samaritan Hospital, Legacy Salmon Creek Hospital, Legacy Mount Hood Medical Center and Legacy Meridian Park Hospital. The program has been well-received across the hospital system and doctors consider the program an essential part of providing excellent care to patients, said Jones.
At Good Samaritan Hospital, the team has been called to a patient’s bedside more than 50 times between January and April. Within the first month of the program, both Good Sam and Mount Hood reported very positive patient outcomes and satisfaction among team members.
“Because of the Rapid Response Team, patients experiencing a decline in condition can be assessed (and treated if necessary) very quickly. I believe this will likely prevent many patients from coding or being unnecessarily transferred to the ICU,” Dr. Gordon said.
The RRT program is providing learning opportunities for nursing and other patient care staff.
“The RRT has increased the level of confidence that nursing staff have in the support available to their patients on the acute care units. It has added yet another important layer of care for our patients at Good Sam,” said Lewis Low, M.D., F.C.C.M., F.A.C.P., medical director of the Legacy Inpatient Medicine Service and medical director at the Legacy Good Samaritan Kern Critical Care Unit.
Legacy’s Rapid Response Team program is supported by CareOregon’s Care Support and System Innovation (CSSI) Program. CareOregon is partnering with health care providers across the state to deliver innovative system changes in an effort to deliver better patient care. CSSI projects respond to an Institute of Medicine call to action to improve the health care delivery system by emphasizing system enhancements that are safe, effective, patient-centered, timely, efficient and equitable. The projects address areas of importance to CareOregon members: complex care management, chronic care management, reducing health disparities, improving access to care and office efficiency, and increasing patient safety.
A number of CSSI projects were also part of the recently culminating “100,000 Lives Campaign” initiated by the Institute for Healthcare Improvement. The campaign sought to prevent 100,000 unnecessary deaths by dramatically improving patient care. Implementation of rapid response teams was among the six evidence-based and life-saving interventions included in the campaign. Nationwide, more than 3,000 hospitals – including the Legacy Hospital System – participated in the 18-month-long campaign.
