Reducing hospital standardized mortality rate with early interventions

John Mailey, Bruno Digiovine, David Baillod, Gwen Gnam, Jack Jordan, Ilan Rubinfeld
Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses 2006, 13 (4): 178-82
Henry Ford Hospital is undertaking multiple initiatives to reduce patient mortality. One such project is the deployment of a rapid response team (RRT). Rapid response teams contribute to reducing in-patient mortality rates by identifying and treating patients at risk for physiological deterioration outside the intensive care unit (ICU) setting. Rapid response teams differ from code teams because they proactively look for "at-risk" patients, whereas code teams are activated after a patient's arrest. Team members include ICU nurses, medical doctors, house managers, and respiratory therapists, with the ICU nurses acting as primary responders. The RRT at Henry Ford Hospital is available 24 hours a day, 7 days a week. Criteria for the members of the RRT were developed by a committee of physician and nursing leadership. Nurses on the RRT need a minimum of 2 to 3 years of intensive care background. Weekly meetings with planning committee members were held to discuss issues regarding the implementation of the RRT pilot. The RRT committee consists of 3 nurse administrators, a house manager, a clinical nurse specialist, 2 nurse managers, clinical coordinators, a quality assurance nurse, a statistician, and the medical director of medical critical care. The population analyzed was a sample of 1,335 RRT consults and 207 medical ICU discharge follow-ups. The processes that were measured were percentage of blue alerts outside the ICU, the number of calls to the RRT, and the location, reason, time, and outcome of an RRT call. Outcome measures consisted of unadjusted hospital mortality rate, blue alerts per 1,000 discharges, percentage of patients with blue alerts discharged alive, and number of days between blue alerts on the pilot unit. Initial results are positive, with evidence that the number of blue alerts on general practice units is being reduced. Statistical data collected from the consult forms indicate that the greatest number of occurrences were respiratory triggers. From a sample size of 1,335 consults, 30% of the sample group had low pulse oximetry, 30% presented with respiratory distress, and 20% had respiratory rate issues. Future implications for the RRT will be along the lines of early sepsis recognition, retention and recruitment tool, education and practice links, and using families as initiators of a RRT consult.

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