Saving lives through rapid response
Sometimes seconds can mean the difference between life and death. When a hospital patient is in critical care, his or her vital signs are monitored closely for signs of an impending medical emergency or "code." Unfortunately, patients who aren't in the Intensive Care Unit (ICU) may also worsen, code and die.
Cardiac arrest, an abrupt stop of normal blood circulation, is one common complication among hospitalized patients. Most patients who have a cardiac arrest have identifiable signs of deterioration prior to the arrest, such as abnormal vital signs and/or hypoxia, a shortage of oxygen in the body. Research shows that only 17 percent of patients who experience an inpatient cardiac arrest survive to discharge. Survival rates are higher when arrests occur in monitored units than in non-monitored units.
"On occasion, a patient has been admitted and is doing well, and then begins to decline rapidly," explains Gail Meyer, RN, 5 Million Lives (5M) Campaign project director. "Frequently this decline is first recognized by the patient's family, because they are the people spending the most time with the patient, or a staff nurse. It might be as basic as a gut feeling that a patient's health status is changing. In addition to immediately notifying the patient's physician of the concern, the rapid response process gives that staff member another avenue for confirming his or her assessment of the patient and taking action."
Attempting to prevent deaths by stabilizing patients whose health is quickly deteriorating is the essence of rapid response. The Iowa Healthcare Collaborative is working with Iowa hospitals of all sizes to promote the development of a rapid response process that any healthcare professionals on duty in the hospital can implement. Saving lives through rapid response is a 5M Campaign initiative.
The IHC goal is to facilitate rapid response implementation at all 117 Iowa community hospitals by the end of 2008. IHC serves as the statewide clearinghouse for educational resources such as rapid response tools provided through the 5M Campaign, and convenes rapid response discussions during 5M Node Work Days twice a year. These meetings give participants from across Iowa an opportunity to hear from national experts and to learn from one another through smaller group discussions.
Setting the pace at the University of Iowa
Hospitals and Clinics
Rapid response makes a difference for approximately 12 to 20
patients every month at the University of Iowa Hospitals and Clinics (UIHC).
A team of professionals led by Dr. John Fieselmann and including other
physicians, nurses, respiratory therapists and emergency room doctors
formed in the spring of 2005 to develop criteria and a consistent process
for rapid response. He says the IHC rapid response Web-based resources
provided a great start, and the team read thoroughly about best practices
at other hospitals.
UIHC implemented two Rapid Response Teams effective July 1,
2005-a medical team and a surgical team that each include a physician,
a nursing supervisor and a respiratory care supervisor. In the following
24 months, the teams have completed 430 rapid response deployments.
Dr. Fieselmann says anyone in the hospital can initiate a rapid response
call. "The team quickly assesses the patient, checks his or
her treatment wishes and assists the primary medical team,"
he says. "They initiate care that may include monitoring the
patient, administering intravenous (IV) medicine, ordering labs, or
transferring the patient to a higher level of care."
The process is yielding lifesaving results for patients such as
a 37-year-old man receiving inpatient care in a UIHC cardiac unit.
The patient hadn't been sick enough to require highly specialized
care in the Cardiovascular Intensive Care Unit (CVICU), but that
changed in an instant when he developed symptoms of critical
heart failure. Fortunately, Cheryl Irland, RN, recognized the
symptoms and called the Rapid Response Team. After assessing
the situation, the team immediately transferred the patient to the
CVICU. He recovered and returned home shortly thereafter. "This
intervention almost certainly saved the patient's life," Dr. Fieselmann says.
This is one of many success stories celebrated at UIHC. In fact, 82 percent of UIHC
patients who are treated with rapid response survive, and approximately 62 percent of them
are able to return to their homes rather than to long-term nursing care.
The Institute for Healthcare Improvement has recognized UIHC as a local and national
rapid response mentor hospital for academic health centers, but Dr. Fieselmann says their
learning process continues. "It is gratifying to participate in the IHC Node Work Day events
and share stories with other hospitals," he says. "We learn as much from them as they learn
from us. It's a great way to continue improving."
