A study conducted by Beth Israel Deaconess Medical Center researchers has established that a care system that is focused on detecting and systematically assessing patients with clinical instability can produce similar outcomes as rapid response teams that consist of trained intensive care specialists. The study was published online in Critical Care Medicine.
The findings are based on an assessment of 177,347 patients over a 59-month period. In recent years, rapid response teams have become an important part of hospital care. The teams dispatch professionals trained in critical care to the bedside of patients whose health is deteriorating. Most U.S. rapid response teams dispatch a special ICU-based team of additional providers to these patients’ bedsides.
Michael D. Howell, MD, MPH, a critical care specialist at BIDMC and Assistant Professor of Medicine at Harvard Medical School explained:
“We found that a rapid response team that relied on providers already assigned to a patient’s care, rather than a separate ICU-based rapid response team was associated with a marked reduction in the rate of unexpected mortality.”
Triggers, a new model of rapid response team, which is different to the usual rapid response teams’ approach was launched by the BIDMC in 2005. In contrast to the usual rapid response teams, Triggers does not add additional clinical staff to the patient’s care, instead it organizes the response of the patient’s existing care providers.
Trigger team members include the patient’s nurse, intern, respiratory therapist, and the floor’s senior nurse, who all respond to a patient’s bedside depending on various diagnostic factors being triggered. These include the patient’s blood pressure, heart rate, respiratory rater, oxygen saturation or urine output charge within set parameters. If a nurse is concerned about the status of a patient, he or she can also ‘trigger’ the rapid response team, a feature that has been extended in recent years to include concerned patients or family members. If the initial evaluation requires a follow-up, the senior attending physician or resident must be notified.
An examination of case studies from 2004 to 2008 revealed that 65% of all patients admitted to hospital were less likely to die unexpectedly because of the Trigger program and that the risk of overall in-hospital mortality was 5% lower, although the significance of this was not statistically different. These findings are nevertheless significant for clinicians and policymakers.
Howell states: “Our lower-staffing intensity approach produces outcomes comparable with ICU-based approaches. This approach requires no additional clinical staffing, preserves provider continuity (which may limit adverse events and respects traditional tenets of medical education.”
In view of the arising problems due to shortages in intensive care staff, who are utilized to perform out-of-ICU duties, especially in smaller hospitals, the researchers point out that, “it may be that intensivists’ time is better spent with the critically ill in the ICU rather than serving as part of a rapid response team.”
Written by Petra Rattue