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Hospitals Urged to Develop Rapid-Response Teams


 

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.”

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute myocardial infarction, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using these teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

The clinicians assigned to the team must be ready to respond quickly, Ms.Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated the use of the SBAR (situation, background, assessment, and recommendation) technique, developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Hospitals Face Growing Public Impatience

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year due to preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error. Overall, 92% of those polled said there should be public reporting of medical errors.

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