199529 Deploying a Rapid Response Team in Ambulatory Care to Decrease Adverse Clinical Outcomes

Monday, November 9, 2009

Marcie Sara Rubin, MPH , Business Development/Ambulatory Care Services, Metropolitan Hospital Center, New York, NY
Pranav Mehta, MD , Ambulatory Care Services, Metropolitan Hospital Center, New York, NY
Richard Stone, MD , Medical Director, Metropolitan Hospital Center, New York, NY
Background: While studies have shown the benefits of Rapid Response Teams (RRTs) in inpatient services, there is relatively little information regarding the use of RRTs in ambulatory care. Since substantial risks to patient exist in ambulatory care, establishing RRTs in ambulatory care stands to impact this state of affairs by identifying unstable patients and those patients likely to suffer cardiac or respiratory arrest. If identified in a timely fashion, their unnecessary deaths can often be prevented. Methods: The RRT was deployed hospital-wide in February 2007 to include ambulatory care. The team members consist of a Medical Intensive Care Unit Nurse, Third year Medical Intensive Care Unit Resident and Respiratory therapist. The team members were made available to respond immediately when called through beepers and an overhead page by the hospital operator. All staff were trained and empowered to call for an RRT when the required criteria was met. Results: The deployment of a RRT team in ambulatory care was associated with a decrease in adverse clinical outcomes with no cardiac arrests or mortalities, thus increasing patient safety and improving the quality of care provided to the hospital's patients. Ambulatory care is often an area seen as not needing a RRT team; however, the results show that some ambulatory care patients are in need of medical interventions that are not provided in the outpatient setting, and without the RRT to bring this to the attention of staff who are qualified to intervene, patients might not be receiving the care that they need. Conclusion: This study demonstrates the effectiveness of deploying a RRT for ambulatory care. Our experience shows that physicians and nurses in ambulatory care respond positively to the RRT due to early implementation of care and prompt transfer of the patient to the Emergency Department, Medical Units or the Medical Intensive Care Unit. Another advantage of the RRT program was an improvement in the patient safety culture as a result of better collaboration between physicians and nursing staff. Further studies are needed on the effectiveness of RRT in ambulatory care to evaluate system approaches to improving patient safety and quality of healthcare. As the scope of ambulatory care increases over the next decade with an increase in volume and complexity of cases RRTs will decrease adverse clinical outcomes and improve patient safety, resulting in better communication between physicians, nurses and their patients.

Learning Objectives:
1. Demonstrate the benefits associated with expanded Rapid Response Teams (RRTs) to Ambulatory Care settings. 2. Evaluate the success of implementing an RRT program in ambulatory care in a public acute care hospital in a socioeconomically disadvantaged community. 3. Discuss reasons for the need to expand RRT programs in similar hospital/clinic settings.

Keywords: Quality Improvement, Evidence Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have an MPH in public health policy & management from Columbia University. I have served as a member of the RRT committee at Metropolitan Hospital Center as the Director of Patient Safety for the organization.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.