Rapid Response Teams:

Transcription

1 Rapid Response Teams: Interdisciplinary Collaboration & Quality Improvement Society of General Internal Medicine Workshop April 25, 2014 Background & Meeting Theme: Rapid Response Teams (RRTs) have become the primary means by which hospitals and health systems identify and intervene upon inpatient clinical deterioration. RRTs have proliferated nationally and internationally over the last 15 years, the majority of which are interdisciplinary and may include physicians (generalists or specialists, attendings or residents), physician assistants, nurses, and respiratory therapists. In addition to uncertainty regarding the extent to which RRTs improve patient outcomes, questions remain with respect to the evaluation and improvement of RRT performance and reconciliation of the wide variability in the structure, function, and timeliness of RRTs across institutions. Our interdisciplinary group (with physician and nursing representation) partners to improve health by considering the Rapid Response Team as an integrated, patient-centered safety measure bridging hospital silos to provide essential care to clinically deteriorating inpatients.

2 Yale Faculty Contact Information Chris Sankey, MD Academic Hospitalist, Assistant Professor of Medicine; Medical Director, Rapid Response Team, Yale-New Haven Hospital; Co-Chair, RRT Interdisciplinary Steering Committee; Physician leader of RRT Evaluation & Escalation Subgroup Grace Jenq, MD Associate Professor of Medicine; Medical Director of Inpatient Medicine, Yale-New Haven Hospital Judy Petersen, RN Safety and Quality Project Manager, Yale-New Haven Hospital Sarah Apgar, MD Hospitalist, Northeast Medical Group/Yale-New Haven Hospital; Physician leader of RRT Huddles & Education Subgroup Michael Yoo, MD Hospitalist, Northeast Medical Group/Yale-New Haven Hospital; Physician leader of RRT Information Technology Subgroup

3 Workshop Outline: I. Introduction/Large Group Session (15 minutes) II. Small Group Sessions (60 Minutes) Each participant will rotate through 4, 15-minute small group sessions led by a faculty facilitator as follows: 1. RRT Barriers (Grace Jenq) Generate a dialogue about common barriers to RRT care 2. RRT Huddles (Sarah Apgar) Participate in a mock huddle to introduce the concept as a potential safety intervention 3. RRT Information Technology (Michael Yoo) Share ideas about currently available and desired technology to improve the RRT process of care 4. RRT Quality Improvement (Judy Petersen) Strategize and share ideas regarding RRT process improvement III. Wrap-Up/Large Group Session (15 minutes)

4 RRT Self-Evaluation 1. What are the major barriers to the effectiveness of the RRT at my hospital/institution? (Small Group #1) 2. How can the concept of a safety huddle be used to improve the RRT at my hospital/institution? (Small Group #2) 3. What information technology exists at my hospital/institution, and how can it be leveraged to improve the RRT process of care? (Small Group #3) 4. What quality improvement initiatives should be considered at my hospital/institution? Who do I need to engage and what kind of support do I need for these initiatives to have an opportunity to succeed? (Small Group #4)

5 RRT Action Plan The idea(s)/intervention(s) that I plan bring back for consideration to improve the RRT process of care at my hospital/institution is (are):

6 Yale RRT Metric Report Card

7 RRT Reading List 1. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med 2011;365(2): Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid- Response Systems as a Patient Safety Strategy A Systematic Review. Ann Intern Med 2013; 158(5 Pt 2): Benin AL, Borgstrom CP, Jenq GY, Roumanis SA, Horwitz LI. Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators. BMJ Qual Saf 2012;21(5): Shearer B, Marshall S, Buist MD, Finnigan M, Kitto S, Hore T, Sturgess T, Wilson S, Ramsay W. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service. BMJ Qual Saf 2012;21(7): Winters BD. Rapid response systems: going beyond cardiac arrest and mortality. Crit Care Med 2013;41(3): Buist M. The rapid response team paradox: why doesn't anyone call for help? Crit Care Med 2008;36(2): Jones DA, Dunbar NJ, Bellomo R. Clinical deterioration in hospital inpatients: the need for another paradigm shift. Med J Aust 2012;196: Lippert A, Petersen JA. Rapid response systems--more pieces to the puzzle. Resuscitation 2013;84(2): Ludikhuize J, Dongelmans DA, Smorenburg SM, Gans-Langelaar M, de Jonge E, de Rooij SE. How nurses and physicians judge their own quality of care for deteriorating patients on medical wards: self-assessment of quality of care is suboptimal*. Crit Care Med 2012;40(11): Tee A, Calzavacca P, Licari E, Goldsmith D, Bellomo R. Bench-to-bedside review: The MET syndrome--the challenges of researching and adopting medical emergency teams. Crit Care 2008;12(1): Davidoff F. Heterogeneity is not always noise: lessons from improvement. JAMA 2009; 302(23):