Rapid response: A quality improvement conundrum

• Published in: Journal of hospital medicine Vol. 4; no. 4; pp. 255 - 257
• Main Authors: Prado, Renata, Albert, Richard K., Mehler, Philip S., Chu, Eugene S.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2009
• Subjects: Anticoagulants - therapeutic use; Bipolar Disorder - complications; Bipolar Disorder - psychology; Diabetes Insipidus - chemically induced; Diabetes Insipidus - complications; Female; Fibrinolytic Agents - therapeutic use; Heparin - therapeutic use; Humans; Hypernatremia - chemically induced; Hypernatremia - complications; Lithium Compounds - adverse effects; Mental Status Schedule - standards; Middle Aged; Patient Discharge; patient safety; Pulmonary Embolism - diagnosis; Pulmonary Embolism - drug therapy; quality improvement; rapid response; Thromboembolism - prevention & control; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Urinary Tract Infections - complications
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.430

Many in‐hospital cardiac arrests and other adverse events are heralded by warning signs that are evident in the preceding 6 to 8 hours. By promptly intervening before further deterioration occurs, rapid response teams (RRTs) are designed to decrease unexpected intensive care unit (ICU) transfers, cardiac arrests, and inpatient mortality. While implementing RRTs is 1 of the 6 initiatives recommended by the Institute for Healthcare Improvement, data supporting their effectiveness is equivocal. Before implementing an RRT in our institution, we reviewed cases of failure to rescue and found that (1) poor outcomes were often associated with attempts to manage early decompensations without a bedside evaluation, and (2) the common causes of decompensation for floor patients (early sepsis, aspiration, pulmonary embolism) were within the scope of our primary teams' practice. Therefore, we felt that prompt, mandatory bedside evaluations by the primary team would decrease untoward outcomes. Journal of Hospital Medicine 2009;4:255–257. © 2009 Society of Hospital Medicine.