“Rapid Response” Sees Surprise Patient Benefits
For the thirty New York-area hospitals participating in the Rapid Response System Collaborative, some unanticipated benefits are emerging, yielding dramatic improvements in patient safety and quality of care.
“A sudden change in a patient’s condition will trigger a nurse, doctor, transporter, nurse’s aide, or even family member to call the rapid response team,” explains Alicia DiLavore, RN, nurse manager of the Surgical Progressive Care Unit at Syosset Hospital, speaking from her former experience as quality management coordinator for nursing critical care at Plainview Hospital. Such teams bring specially designated staff to patients’ bedsides at the earliest warning signs of impending crisis, such as cardiac arrest. “On several occasions,” Mrs. DiLavore notes, “it turned out that patients were not on the verge of experiencing cardiac arrest. Instead, the team approach provided the opportunity for early identification of sepsis, a potentially fatal bacterial infection.”
As a result, “We provided additional education for nurses relating to sepsis recognition, and changed our approach to fluid management in the Emergency Department. These interventions led to rapid response team calls related to sepsis significantly dropping, by almost 50 percent, clearly demonstrating improved patient care.”
At John T. Mather Memorial Hospital, the rapid response team noticed that several oncology patients for whom the pain medication morphine was prescribed were oversedated. Realizing that undermedication can leave patients in pain and that appropriate treatment entails a delicate balance, the team recommended an institutional medication review for such patients. That yielded new hospital-wide guidelines regarding dosages, and produced a sedation scale (to accompany the standard pain scale) to assist and inform nurses. “The hospital credits the work of the rapid response team with addressing a previously unidentified medication management issue, which also deals with the Joint Commission’s rigorous standards for medication management,” says Lorraine Farrell, NP, family nurse practitioner.
At Vassar Brothers Medical Center, “The team’s expertise allows us to redefine the goals of care and better involve patients’ family members—many of whom appreciate the opportunity to tell us what their loved one would and wouldn’t want, including end-of-life care decisions,” says Lisa Ricker, NP, nurse practitioner/rapid response coordinator. “Because of the frequency of these calls, we have developed a new working relationship with our palliative care consult service, which has helped improve patient comfort, ease the burden on family members, and prevent inappropriate usage of our limited resources.”
Andrea Hoberman, program manager at the Fund, concludes, “These quality improvement results touch on more
aspects of patient care than we expected, making a difference for patients, staff members, and bottom lines alike.”