Top Rapid Response Teams Have Increased Autonomy

A new study found that in top-performing hospitals, rapid response teams (RRT) have a dedicated staff and clear autonomy. Published in JAMA Internal Medicine, the study examined RRT programs at nine hospitals to determine how they differed between facilities that provided resuscitation care.

Researchers interviewed 158 hospital staff members including nurses, physicians, and administrators during site visits to nine hospitals participating in the Get With the Guidelines-Resuscitation program. The RRTs at top-performing hospitals for resuscitation care had dedicated staff without competing responsibilities, served as a resource for bedside nurses to provide surveillance of at-risk patients, collaborated with nurses during and after a rapid response, and could be activated by a member of the care team without fear of reprisal.

According to the study, in-hospital cardiac arrest (IHCA) affects more than 200,000 patients annually in the U.S. RRTs are part of a strategy to prevent IHCA and are used by most acute-care hospitals in the country. The cost of staffing and maintaining an RRT is estimated at more than $1 million over a five-year period at a medium-size hospital.

For hospitals considered not to be top performers, the researchers found there was more of an ad hoc approach to RRTs, where new members were routinely brought to the teams; the new members had varying levels of skill and communication and may have hindered the success of the teams. RRT activations were treated as individual events addressed in the moment and were less likely to provide collaborative opportunities for shared learning and improvement over time, according to the study. Fear of reprisal and worries over being judged as less competent may have led to a reduced willingness from nurses to activate an RRT.