PC1236: Improving the Process of the Rapid Response Team (RRT) at a Tertiary Care Hospital

Purpose/Objectives: Multidisciplinary rapid response teams (RRTs) provide care for decompensating patients, facilitate transfer to higher levels of care, and improve patient outcomes. The aim of our quality improvement project is to improve communication during our RRT process in order to facilitate efficient transfer of information amongst key stakeholders (residents, fellows, nurses), provide safe transfers of care, and promote a culture of safety.

Design/Methods: We administered a modified version of a validated RRT Facilitators and Barriers Survey to all stakeholders. We then conducted focus groups to define the current state of RRTs, focusing on workflow and communication. A multidisciplinary team with key stakeholder representation was formed to define the ideal RRT state and identify key drivers and countermeasures. A “Pediatric RRT Activation Guideline” and an “RRT Checklist” were developed to facilitate standardized workflow and communication. Following a PDSA cycle, we made adjustments to the checklist and developed a widespread educational series targeting each stakeholder.

Results: Pre-intervention surveys were completed November 2019 to November 2020. Post-intervention surveys were completed February 2022 to April 2022, three months after education roll out. Key outcome measures included stakeholder understanding of the RRT process and team member roles and satisfaction with their education. In total, 140 pre-and 116 post-intervention survey responses were obtained including 56 and 45 residents, 13 and 5 PICU fellows, 31 and 14 RRT nurses, 44 and 42 floor nurses, and 10 hospitalist faculty (post only).

Resident knowledge of: when to call an RRT increased from 73% to 100%, understanding their own role in the RRT increased from 71% to 89%, knowing about RRT protocols increased from 46% to 68%, and receiving regular continuing education about RRTs increased from 24% to 50%. For the PICU fellows, implementation improved the proportion that felt they received regular education about RRTs from 0% to 60% (all significant at p< 0.05).

After implementation of our countermeasures, 94/110 (85%) of respondents reported knowing what to present and (89%) who is present at an RRT. Almost 90% felt that their concerns were heard during RRTs. Of those who knew and utilized the new RRT checklist, 52/74 (70%) felt the checklist should continue to be utilized and that it helped with shared decision making. Despite this, only 30% felt that it delivered more timely and appropriate care. Interestingly, 40% of RRT nurses felt that the checklist should not be continued and that it hindered patient care.

Conclusion/Discussion: While the majority of respondents felt that the checklist should continue to be used, refinements are necessary to make the checklist less of a hindrance to timely care. By clearly understanding the current state, clarifying the ideal state, identifying key drivers and feasible countermeasures, we have standardized communication and improved teamwork during high stress situations.