When people suddenly become ill or injured at home or in the community, they or their families or friends can call 911 for emergency help. But who can a patient or family member call upon once they arrive at the hospital if they feel their condition is seriously deteriorating and nobody is listening? Many hospitals today are offering patients and families an opportunity to summon an interdisciplinary care team to the bedside if they have unaddressed concerns. These teams are called Rapid Response Teams (RRTs).
The idea is simple: any patient or family member can bypass the typical chain-of-command and call what is essentially a medical "SWAT team" to quickly assess the patient and intervene when lifesaving care may be needed. A nurse or any other healthcare provider can also summon the team. Most teams include a highly trained critical care nurse and a respiratory therapist, and many teams include a physician or nurse practitioner. Unlike the traditional medical team that responds when a patient stops breathing or the heart stops beating (cardiac arrest), the RRT intervenes before these often fatal adverse outcomes occur. The goal of RRTs is to identify seriously ill patients, at-risk patients, and patients whose condition is deteriorating unexpectedly, and to trigger an urgent response by clinicians who have the skills and knowledge to deal with the emergency before the patient worsens or dies.
Almost a decade ago, the University of Pittsburgh Medical Center (UPMC) Shadyside was perhaps the first hospital in the nation to invite patients and families to call for a RRT to address unresolved concerns about their safety and health. Upon admission, patients and family members were encouraged to pick up any phone in the hospital to report a Condition H (for "help") if they:
Fear something is seriously wrong with the patient and have expressed their concerns without validation or recognition of its importance.
Experience a communication failure with the healthcare team.
Become confused about the patient's care.
Need to know where to voice concerns about the patient's deteriorating clinical condition.
Feel something about the patient's condition is "just not right."
Today, RRTs are widely used in hospitals. The general concept is sound—if we encourage all who observe the patient, including the family and patient himself, to call for help when needed, and if we send in a team of the right people with the right skills and knowledge at the right time, we should be able to rescue patients before their breathing or heart stops (cardiac arrest).
The results of studies to determine whether these teams work have been mixed. For example, a 2010 study found that RRTs reduced the risk of cardiac arrest in adults by 34%. But the number of patients who died in the hospital was not significantly lower. With children, the study found that RRTs reduced the risk of cardiac arrest by 38% and the risk of death by 21%. A more recent analysis published in 2014 found that RRTs may reduce cardiac arrests by up to 50% and deaths during hospitalization by up to 33%. So, there is some evidence that allowing staff, patients, and families to summon a RRT can save lives. If you or a family member is hospitalized, ask if they have a patient-activated RRT program.
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