The centerpiece of one of the most successful national public health initiatives in years is in place and making a difference in clinical outcomes at New Hanover Regional Medical Center.
The Rapid Response Team has reduced “codes,” or emergency calls for critical intervention, outside the intensive care units from 68 percent to 45 percent in a little more than a year. This means that patients who were on a general floor unit outside an ICU are about a third less likely to require an emergency intervention.
The implementation of Rapid Response Teams is a key component of the 100,000 Lives Campaign launched 18 months ago by the Institute for Healthcare Improvement. About 3,100 hospitals, including New Hanover Regional, are taking part. The goal is for hospitals to consistently apply six evidence-based and life-saving interventions and prevent 100,000 deaths nationwide.
The IHI announced earlier this month that the campaign has prevented an estimated 123,300 deaths, based on mortality data from participating hospitals.
“We in health care have never seen or experienced anything like this,” Dr. Dennis Leary, president of the Joint Commission on Accreditation of Healthcare Organizations, was quoted as saying in national publications.
New Hanover Regional’s primary contribution to this effort was the Rapid Response Team that began in June 2005. The team, which includes a Registered Nurse and Respiratory Therapist, is on call at all times and serves as a resource to the nurses and other clinicians on the floors of the hospital. It has been deployed more than 200 times.
A “code” is called when a patient’s heart has stopped or the patient has stopped breathing. Codes are generally associated with the intensive care units, where trained personnel use specific equipment to address them. However, because some symptoms of a deteriorating patient can begin up to eight hours before the patient actually codes, the RRT may be called to a general floor bed at the beginning signs of decline, possibly preventing the patient from reaching a full-blown code. Any nurse concerned about a patient’s condition can activate the team.
The team assesses and stabilizes the patient, assists with communication, and offers support to the floor nurses. After the response, team members debrief with the patient’s nurse to discuss what they found and how it was resolved.
Jill Apple, the team’s clinical coordinator, said earlier this month she and a respiratory therapist responded to the bedside of a 47-year-old woman who had become unresponsive, with her concerned mother looking on.
In a matter of minutes, the patient was responding to her mother, and the next day, she was able to sit up and eat. Without quick intervention, she likely was headed for a ventilator, Apple said.
“It’s absolutely rewarding,” she said. “That was a turnaround. That would have been a whole other experience for her mother to follow her to an ICU and watch her get intubated.”
Apple said New Hanover Regional has been so successful that the medical center is considered a mentor hospital for others implementing the program.