Orlando Regional Medical Center
Introduction: Rapid Response Teams (RRT) traditionally respond to patient deteriorations identified by nurses outside of the ICU. ICU admissions from inpatient areas are indicators of physiological decline and are associated with increased mortality. Next steps for RRT are to proactively identify patients at-risk, and to act as a resource to increase anticipatory nursing care while promoting expertise-sharing among nurses.
Hypothesis: Increased presence of a Rapid Response Team RN (RRT RN) guided by warning score algorithms to proactively round on patients at risk for deterioration can decrease the number of unplanned ICU transfers.
Methods: Proactive rounds by an RRT RN in all inpatient areas of a 270-bed community hospital were guided by algorithms (Rothman Severity of Illness Index) within the EMR to identify patients at risk for deterioration. The RRT RN inspected graphics (vital signs, laboratory values, nursing assessments and an indexed value) and proactively rounded on 8+ patients per day while delegating additional patients to charge RNs for follow-up. Reasons and interventions for each visit were recorded prospectively (October 2011–March 2012). Data was collected retrospectively for the prior 12-month period for comparison using Wilcoxon rank sum tests. A reactive RRT remained active during both periods.
Results: Proactive visits were conducted on 1,444 occasions. Nursing-driven interventions were implemented 533 times (37%). When interventions resulted from proactive rounds, they were most often related to anticipatory nursing care such as coaching on vital signs (48%), calls to providers (36%), or diagnostics (36%). ICU transfers from wards were not significant, but transfers from Intermediate Critical Care Units (ICCU) decreased significantly (3.16/1,000 patient days vs 1.91/1,000 patient days, p=.028).
Conclusions: Differences in the frequency of assessments between the wards and ICCUs may contribute to changes in detection of patient instability. The interventions and coaching on anticipatory nursing care to staff RNs during proactive rounds may be associated with a dramatic increase in the stabilization of patients in ICCUs and corresponding decreases in unplanned ICU transfers.