Since its implementation in December 2005, the Stanford Rapid Response Team (RRT) has responded to an average of 30 calls monthly to help hospitalized patients who display signs of acute deterioration, said Ann Weinacker, a critical care faculty member who serves as medical director of the team.

The RRT can be called to any inpatient unit in SHC, but the majority of calls have originated from F ground (Oncology/Hematology), B2 (Intermediate Care Unit), C3 (Orthopedics) and D ground (Medicine), Weinacker said. About half of the calls occur between 7 p.m. and 7 a.m.

Although the RRT can be called by nurses, physicians, or respiratory therapists, nurses are by far the most frequent activators of the RRT. “Interestingly, however, physicians call the RRT for help in approximately 15 percent of cases,” Weinacker said. She added that a plurality of calls are for acute respiratory insufficiency, 38 percent, while altered level of consciousness was the second most common trigger at 18 percent. Hypotension was another frequent trigger of calls.

The medical director said about half of the patients are transferred to an intensive care unit after an RRT call, exceeding the Institute of Healthcare Improvement’s [IHI] estimate that 20 percent of RRT-treated patients will be moved to an ICU.

The higher number of ICU admissions “may reflect a delay in calling the RRT when a patient’s condition begins to deteriorate. For this reason, a major educational campaign for nurses will soon begin in an effort to improve early recognition of clinical signs indicating that a patient’s condition is worsening,” Weinacker said.

“Since institution of the RRT, there has been a decrease in the number of Code Blue calls for ‘medical emergencies’, but not in the number of code calls for true cardiopulmonary arrest. The hospital mortality rate also has not declined,” she said.

“The IHI has determined that a minimum of 25 calls per 1,000 discharges are necessary to see any impact on mortality - a number that may not be achieved (or necessary) in an academic center like Stanford where physicians are present in significant numbers 24 hours a day. A major goal of the RRT, however, is to decrease the number of cardiopulmonary arrests, and the RRT is working with the CPR Committee to determine how to achieve this goal, Weinacker explained. She added that the RRT has been well received by nurses, physicians, and other clinicians at SHC.

The team consists of a critical care fellow, two critical care nurses, and a respiratory therapist who respond to calls within approximately 10 minutes. A pharmacist is also immediately available to the team.

The RRT currently responds only to inpatient units in SHC and to the Ambulatory Treatment Unit. Emergencies in other locations in the hospital, such as the laboratory or the cafeteria, or the Cancer Center or Boswell Clinic Building, are managed by the institution-wide Code Blue Team.