Condition Help: A patient- and family-initiated rapid response system

In recent years, rapid response teams (RRTs) have been widely implemented to improve patient safety and quality of care. RRTs traditionally are activated by providers to address a clinically deteriorating patient; trained nurses, respiratory care specialists, and physicians are brought bedside to assist in triage and management. After the Joint Commission¹ endorsed patient engagement as a strategy for enhancing patient safety, new initiatives were developed to meet the challenge. Programs designed to enhance patient engagement have taken a variety of forms, including educational campaigns encouraging patients to report adverse events, requests for handwashing by providers, and the institution of patient- and family-activated RRTs.² Patient involvement is viewed favorably and has been shown to increase patients’ perception of health care quality.³ Although these initiatives are presumed helpful in encouraging communication, there is limited evidence that more communication leads to safety improvements. Despite the increasing prevalence of patient-activated RRTs in the United States, they have gone largely unevaluated in the adult population, and their efficacy remains unclear.

Condition Help (CH) is a patient- and family-initiated RRT designed to prevent medical errors and communication problems and improve patient safety. Patients and families are encouraged to call the CH hotline if they believe that there has been a breakdown in care or that their health is in imminent danger. This RRT was inspired by the case of Josie King, an 18-month-old girl who died of preventable causes at a large children’s hospital.⁴ After her daughter’s death, Sorrel King started the Josie King Foundation, an organization committed to preventing medical errors and creating a culture of patient safety. With the support of this foundation, CH was launched in 2005 at the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center (UPMC). Later it was implemented at the UPMC adult tertiary-care center, and now it is available in all UPMC facilities.

On admission, patients receive a brochure that details the purpose of CH and provides examples of when and how to call the CH hotline. In this brochure, patients are instructed to call CH in 3 situations: “1) There is an emergency and you cannot get the attention of hospital staff, 2) You see a change in the patient’s condition and the health care team is not recognizing the concern, or 3) There is breakdown in how care is given or uncertainty over what needs to be done.” These instructions are printed on bulletins placed in elevators and hallways throughout the hospital. Patients and families may activate the system at any time and can even do so from home.

When a patient or family member calls the hotline, an operator notifies the CH team. This team, which consists of a patient care liaison (or an on-duty administrator) and the unit charge nurse, convenes bedside to address the patient’s concern. The team was designed without a physician to ensure that the primary team remains in charge of the care plan. CH is kept separate from our traditional RRT and does not compete for resources (personnel, equipment, time) with the RRT, which is designed to address a clinically deteriorating patient.

In this article, we describe the characteristics of patients for whom CH was activated at our adult hospital. We also describe reasons for calls, whether changes in care were implemented, and outcomes, including traditional RRT activation, transfer to intensive care unit (ICU), and inpatient mortality. As CH was designed with patient safety as a goal, we tracked 2 types of calls, those involving safety issues and those involving nonsafety issues.