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MD Hospitals Offer Innovative New Groups to Create and Maintain Rapid Response Teams to Reduce Morta

Posted on: Friday, 17 February 2006, 21:00 CST

By Karen Buckelew

When Jenepher Piper was released from a Towson hospital following surgery recently, the last thing on her mind was dying.But by the time the 40-year-old got to her Cockeysville home, she was on her way to extinction. Her calcium and electrolyte levels plummeting, Piper rushed back to St. Joseph Medical Center.She was met and treated by the hospital's new rapid response team. If not for the innovative new group, Piper, a nurse practitioner herself, believes she would have died.If they didn't have that in place, I probably wouldn't be here, Piper said.St. Joseph Medical Center is one of the more than 3,000 hospitals nationwide - and one of the 11 in the Baltimore area - developing new methods to intervene before patients' vital signs reach the most critical point, when their hearts stops or they cease breathing - in hospital lingo, code blue.Only about 11.9 percent of patients who code return home, according to the Institute for Healthcare Improvement.But as part of its 100,000 Lives Campaign, the institute is encouraging hospitals to create and maintain rapid response teams for early intervention.St. Joseph's new team - consisting of a critical care nurse, a respiratory therapist and a critical care physician - is standing by in the hospital at all times, waiting for calls from nurses concerned about their patients' rapidly declining condition.That's exactly the point, according to Kathy Duncan, the Arkansas registered nurse working for the institute as an advisor to hospitals looking to implement such teams.The key is identifying the five or six signs that patients are on their way to coding and training nurses to call for the response teams when patients exhibit one or several of those signs, before the situation is dire.Australian studies supporting the response-team concept have found about a 35 percent reduction in mortality rates among hospitals that use the teams, Duncan said.And the American hospitals reporting data to the institute as part of the 100,000 Lives Campaign are seeing a 20 percent to 25 percent reduction in their mortality rates, she added.What we're finding is - we're having every bit as good outcomes [as in Australia] and even better, because we're getting to people earlier and getting them the help they need, Duncan said.The goal of the campaign, which launched in January 2005 and ends this June, is to save 100,000 lives using new procedures including the response teams, avoiding medication errors by keeping more detailed records, preventing pneumonia in patients on ventilators and averting infections in patients with central lines.The 3,046 hospitals officially participating in the campaign as of last week represent about 85 percent of the nation's hospital beds, according to the institute.Since implementing the rapid response teams in September, St

. Joseph has seen a 20 percent reduction in its overall mortality rate and a 35 percent decrease in the number of patients who reach code blue status, said Dr. Richard Boehler, vice president for medical affairs and chief medical officer.The hospital has been participating in several facets of the 100,000 Lives Campaign, so not all the improved numbers can be attributed to the response teams.But quite honestly, Boehler said, I don't care how I get there as long as we have success.Other participating hospitals in the Baltimore region include Johns Hopkins Hospital, Mercy Medical Center, Union Memorial Hospital and the University of Maryland Medical Center.Different needsOrdinarily, aggressive tactics would not be used on patients until they coded, experts say. At smaller hospitals such as St. Joseph, when patient's vital signs begin to decline, nurses typically call the patient's physician, who 95 percent of the time is off site, according to Boehler.The physician would advise the nurse on treatment options or, if necessary, come to the hospital to examine the patient.But with the teams on site at all times, the nurse can call them instead for immediate face-to-face evaluations and treatment.It is amazing to me we weren't doing this 10 or 15 years ago, Boehler said. It seems like such the right thing to do.At larger hospitals, such as the University of Maryland Medical Center, the teams are a little different than they are at St. Joseph.Because University of Maryland is a teaching hospital with physician coverage at all hours, night and day, having a physician on the team is not as crucial, said Dr. Carl Shanholtz, medical director of the intensive care unit, the respiratory care department and the mobile practitioner team.University of Maryland is developing its mobile practitioner team, its own take on the rapid response concept. Its team may feature critical care nurses and respiratory therapists to help floor nurses when a higher level of expertise is needed to assist patients, Shanholtz said.One of the hospital's key areas of need, he added, is in the area of skilled transporters for patients. Critically ill patients can't be transported by unskilled workers - they need constant medical supervision.But pulling nurses off the floor to take patients to and from appointments for tests just isn't practical, Shanholtz said. That's why the hospital is looking into creating its own transport service with nurses or respiratory therapists.For the response team to work for each hospital, he said, a certain amount of preparation work is necessary.It's all depending on what needs you want to fill, Shanholtz explained. That's going to direct how you construct the team. That's what requires some study.That's the approach the institute is offering its participating hospitals, according to Duncan. Its Web site, www.ihi.org, is stocked with materials to help hospital administrators develop programs.The concept, though it seems simple, still is very new and developing, experts say. And as Shanholtz pointed out, the teams may not be necessary for all hospitals.But Piper, at least, said she will be eternally grateful for St. Joseph's team. From her room in the hospital's intensive care unit, where she is receiving calcium and electrolytes to keep her levels up, she reflected on her near-code.The whole team saved my life, she said. I'm going to make a full recovery because of their quick actions.PARTICIPATING BALTIMORE-AREA HOSPITALSEleven hospitals in the Baltimore area are participating in the 100,000 Lives Campaign, although not all of them have added rapid response teams. They are:Bon Secours Baltimore Health SystemFranklin Square Hospital CenterGood Samaritan Hospital of MarylandJohns Hopkins Bayview Medical CenterJohns Hopkins HospitalMercy Medical CenterSinai Hospital of BaltimoreSt. Agnes HealthCareSt. Joseph Medical CenterUnion Memorial HospitalUniversity of Maryland Medical CenterSource: Institute for Healthcare Improvement

Source: The Daily Record (Baltimore)

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