Morgan, Georgiann, RN

Pyne, Steven, RRT

Rabert, Anne, MHSA, RN, CCRN, NE-BC

Tavianini, Holly, RN, BSN, MSHSA, CNRN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingRapid Response Team: Increases PatientOutcomes and Nursing Staff Satisfaction.Holly Tavianini RN, BSN, MSHSA, CNRNLehigh Valley Health Network, Holly.Tavianini@lvhn.orgAnne Rabert MHSA, RN, CCRN, NE-BCLehigh Valley Health Network, Anne.Rabert@lvhn.orgGeorgiann Morgan RN, CCRN -CSCGeorgiann.Morgan@lvhn.orgSteven Pyne RRTLehigh Valley Health Network, Steven.Pyne@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtTavianini, H. Rabert, A. Morgan, G. Pyne, S. (2008, October). Rapid Response Team: Increases Patient Outcomes and Nursing StaffSatisfaction. Presentation Presented at: Lehigh Valley Health Network, Allentown, PA.Rapid Response Team:Increases Patient Outcomes and Nursing Staff SatisfactionHolly D. Tavianini, RN, MSHSA, CNRNAnne Rabert, RN, MHA, CCRN, NE-BCGeorgiann Morgan, RN, CCRN - CSCSteve Pyne, RRTRapid Response Team (RRT) – Why Now?• Institute for Healthcare Improvement– 70% (45/64) arrests with evidence of respiratory/neurological deterioration with 8 hours. (Schein, Chest 1990; 98:1388-92)– 66% (99/150) of patients show abnormal signs and symptoms within 6 hours of arrest and MD is notified in only 25% (25/99) of cases. (Franklin C, Mathew J. Critical Care Med. 1994;22(2) :244-247)• 2009 National Patient Safety Goal (NPSG)The Rapid Response Team• …is a team of clinicians who bring critical care expertise to the bedside (or wherever needed)• Goal– Prevent deaths in patients who are failing outside intensive care settings by implementing Rapid Response Teams (RRT)2005 Institute for Healthcare ImprovementSo How Did We Get Started?• We developed the RRT committee– Team of nurse leaders, physicians, and respiratory therapists– Utilized the IHI 100 Thousand Lives Campaign’s RRT Practical Implementation Strategies 2005 and the Getting Started Kit.– Conducted a literature review– Developed criteria for when to make a RRT call• Training for the team members• Staff educationCedar Crest RRT CallsWhat was the reason for the RRT?ResponseNumber of CallsPercentage of CallsRespiratory 150 48.08Heart Rate 48 15.38Blood Pressure 40 12.82Acute Neurological Change 87 27.88Pain 18 5.77Staff Concern 18 5.77Other 44 14.10Stroke Alert 15 4.81020406080100120140Cedar Crest, Med – Surg/Low Level – Year 1 (2006-2007)Feb Mar Apr May June Jul Aug Sep Oct Nov Dec Jan Feb TotalsUnitTOHU 1 1 2 2 1 1 1 9IPCU 4 5 1 2 1 3 1 2 2 21PCU 1 2 3 1 1 3 2 2 2 3 3 6 294A 1 3 2 4 7 4 4 1 1 3 304C 4 4 8 4 1 5 1 1 1 1 2 3 1 365A 1 2 1 1 1 1 1 1 1 105B 2 1 3 1 1 85C 1 5 4 1 6 2 2 2 3 2 3 1 326B 1 8 2 2 2 2 4 1 3 2 4 1 326C 1 7 1 2 3 3 4 1 4 2 4 327A 3 7 4 4 2 4 7 1 8 4 3 4 517B 2 3 2 5 1 4 6 1 2 3 297C 2 4 4 3 4 6 1 2 2 1 29EAU N 1 1 1 3EAU S 1 1 2 1 5Dialysis 1 1 2 2Total 11 30 45 21 25 39 30 33 22 34 19 24 27 360Stroke Alert 1 4 4 1 4 1 4 4 1 1 1 1 1 28Cedar Crest – Time of Call, Year 1(2006 – 2007)Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb TotalsTime0301-0700 2 7 6 3 2 6 4 3 5 4 3 3 5 530701-1100 2 4 7 5 6 6 7 9 4 4 2 4 4 641101-1500 1 2 7 3 5 4 4 4 3 9 4 1 1 481501-1900 2 6 9 3 7 8 7 4 6 4 4 5 5 701901-2300 2 6 11 0 2 9 4 6 2 6 3 5 4 602301-0300 2 5 5 7 3 6 4 7 2 7 3 6 8 65Total 11 30 45 21 25 39 30 33 22 34 19 24 27 360Cedar Crest – Med Surg Unit/Low Level, Year 2 (2007 – 2008)2007 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb TotalUnitTOHU/3K 1 4 0 1 3 0 2 0 0 1 2 1 15IPCU 1 1 3 0 4 1 6 0 2 3 1 0 22PCU 6 2 4 3 3 5 0 2 2 3 1 1 324A 1 2 0 5 3 1 4 1 1 3 4 1 264C/4K 2 3 0 0 2 3 1 3 1 2 1 2 205A 1 1 0 1 1 0 0 2 0 0 0 0 65B 1 0 0 0 0 2 2 0 1 1 1 4 125C 5 1 0 1 0 2 1 1 0 1 2 1 156B 3 6 3 2 7 5 8 7 3 2 3 2 516C 2 2 3 2 5 1 6 6 0 4 2 4 376K 4 6 107A 1 3 7 1 2 2 0 3 3 3 2 3 307B/5K 3 5 1 2 6 3 4 4 2 5 3 4 427C 4 1 1 1 3 3 2 0 3 0 1 2 21EAU N 0 1 0 0 1 0 0 0 1 0 0 0 3EAU S 0 0 0 0 0 1 0 0 1 1 0 0 3Dialysis 0 0 0 2 0 0 0 0 0 0 0 0 2NSICU 1 0 0 0 0 0 0 0 0 0 0 0 1Total 32 34 24 22 42 30 36 31 21 31 29 35 367Cedar Crest – Non-Med Surg Units, Year 2 (2007-2008)Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb TotalMSICU 1 1SSA 1 1 1 3OHU 2 1 3PACU 1 1 1 1 4MRI 1 2 3CT 1 1Radiology 1 1 2PICU 1 1ACU 1 1Total 2 2 1 2 1 2 1 2 2 4 19Cedar Crest – Time of Call, Year 2 (2007-2008)Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb TotalsTime0301-0700 4 10 4 8 10 9 10 5 5 6 7 6 840701-1100 5 4 4 6 5 2 3 3 4 9 3 7 551101-1500 5 5 6 3 2 2 6 3 2 3 7 10 541501-1900 7 4 5 2 9 6 8 7 5 3 2 3 611901-2300 5 6 3 2 10 11 3 11 2 6 5 8 722301-0300 6 5 2 1 6 0 6 2 3 4 5 1 41Total 32 34 24 22 42 30 36 31 21 31 29 35 367Muhlenberg RRT CallsWhat was the reason for the RRT?ResponseNumber of CallsPercentage of CallsRespiratory 57 48.72Heart Rate 18 15.38Blood Pressure 5 4.27Acute Neurological Change 32 27.35Pain 7 5.98Staff Concern 16 13.68Other 23 19.66Stroke Alert 1 0.850102030405060708090100Muhlenberg – Med Surg Units, Year 1(2007-2008)Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Totals2nd 0 0 0 0 0 0 0 1 0 0 0 0 13T 2 1 8 8 7 6 6 9 7 3 4 1 624T 2 5 2 2 4 5 2 5 0 2 4 5 385T 2 1 2 2 1 0 1 3 1 3 4 2 226T 3 3 2 5 2 4 0 3 2 2 3 1 30EAU 0 0 0 0 0 0 0 0 0 0 0 0 0BH 2 0 0 0 2 1 1 2 1 0 0 0 9CT scan 1 0 0 0 0 0 1 0 1 0 2 0 57T 2 0 3 2 1 1 2 3 5 0 0 3 22Totals 14 11 17 20 17 18 14 27 17 12 17 12 204Muhlenberg, Non Med-Surg Units, Year 1 (2007-2008)Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul TotalsGSHCath lab 1 1Heart Station 1 1Pre-op 1 1MRI 1 1 2Nuclear Med 1 1IR 1 1ASU 1 1CT scan 1 1 1 2 5Muhlenberg, Time of Call, Year 1 (2007-2008)Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul TotalsTimes0301-0700 4 0 3 4 1 2 2 3 3 2 3 1 280701-1100 3 0 6 5 4 1 2 3 2 3 3 2 341101-1500 1 3 1 4 1 2 2 5 3 2 1 3 281501-1900 1 3 4 4 5 2 3 4 2 1 4 1 341901-2300 2 1 1 1 4 7 4 6 5 2 4 6 432301-0300 3 4 2 2 2 4 1 6 2 2 2 0 30Totals 14 11 17 20 17 18 14 27 17 12 17 13 197Process Evaluation• Debriefing Tool– Validate need for RRT– Identify reason for calls• Peer Review– Necessity of call– Identify presence of earlier decompensation– Admission to appropriate level of careDebriefing toolDebriefing Tool - continuedCedar Crest -Peer ReviewMuhlenberg – Peer ReviewCedar Crest- Nurse SatisfactionMuhlenberg – Nurse SatisfactionNursing Staff Satisfaction SurveyPatient Outcomes – Cedar CrestTotal Codes Total CodesOutside ICUTotal MortalityTotal DischargesTotal RRT CallsJan – Dec 06 156(0.43%)55(0.15%)715(1.99%)35,987 309*Began Feb 06Jan – Dec 07 209(0.54%)77(0.20%)678(1.76%)38,509 354Patient Outcomes - MuhlenbergTotal Codes Total CodesOutside ICUTotal MortalityTotal DischargesTotal RRT callsJan - Dec 06 19(0.43%)8(0.18%)112(2.52%)4,439 97Jan – Dec 07 57(0.62%)30(0.33%)256(2.77%)9,226 189Expansion and Enhancement of Services• Ancillary Services– Radiology– Diagnostic Care– MRI• Stroke Alert Response• Support to Mother/Baby Unit• 17th Street – transport to ED– TSU, Sleep Center, Short Stay Hospital• Clinical Resource Nurses– Monitor and evaluate patient during the off shift status post RRT callFuture Plans for the RRT• Develop a second RRT for the Cedar Crest site• Support for the Pediatrics RRT• Family Involvement• Physician satisfaction survey• Staff satisfaction survey– Muhlenberg– Ongoing for both sitesRRT Committee Members• Anne Rabert, RN, Director, Co Chair• Georgiann Morgan, RN, Director, Co Chair• Mary Sebastian, RN, VP Clinical Services, Sponsor• Anne Panik, RN, Administrator Clinical Services• Holly D. Tavianini, RN, Director• Uzma Vaince, MD• Maryann Krobath, RN, Nursing Supervisor• Steven Pyne, RRT• Elizabeth Karoly, Clinical Information Analyst• Stephanie Pacelli, Quality Analyst• Kristie Lowery, RN, Risk Management - Patient Safety

Rapid Response Team: Increases Patient Outcomes and Nursing Staff Satisfaction

http://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1798&context=patient-care-services-nursing

Rapid Response Team: Increases Patient Outcomes and Nursing Staff Satisfaction

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works