The rapid intervention team in a supra-regional hospital context: an environmental scan and a unique case study
principal investigators
Marie-Eve Poitras and
Véronique Roberge
Student: Véronique Dauwe
Funding
UQAC Development Fund, UQAC Foundation, Order of Nurses of Quebec, RRISIQ, Regional Order of Nurses of Saguenay-Lac-Saint-Jean-Nord-du-Québec, CIUSSS of
Saguenay-Lac-Saint-Jean, Ministry of Education and Higher Education
study setting
Quebec
themes
Rapid response team, Environmental scan, Single case study, Care team, Implementation modalities
Rapid Response Teams (RTAs) are a strategy to improve the safety of hospitalized patients whose clinical condition is deteriorating. They are found in most hospitals in Australia, North America and the UK and their use continues to expand across the world.
An RIA is a team of healthcare professionals with expertise in critical care, who goes to the bedside of a patient with criteria of physiological instability at the request of the team in charge of the patient on a care unit. .
Before setting up such a team in a supra-regional hospital center, it seems essential 1) to portray the acceptability, implementation and impact of RIAs in Quebec and 2) to explore the needs of the teams. care center in terms of RIAs and the modalities of a future implantation.
What are our goals?
1) Describe the composition and current implementation modalities of RIAs in Quebec
2) Describe the needs of the care teams of the supra-regional hospital center with regard to RIAs
3) Describe the needs of the care teams of the supra-regional hospital center with regard to the modalities of a future establishment
How? 'Or' What?
This research project is divided into two phases: 1) an environmental scan and 2) a single case study.
The environmental scan made it possible to make a review of current practices in Quebec hospitals with regard to RIAs. The single case study made it possible to describe the needs of the care teams of the supra-regional hospital center with regard to RIAs and the modalities of a future implantation in the particular context of the care of a patient whose clinical condition deteriorates. Before exploring the perception of RAS by healthcare teams, participants were asked to describe the current management of an unstable patient.
1. To perform the environmental scan, we used:
Literature paper
Telephone calls to the Nursing Department of 27 Quebec hospitals
Individual interviews with the person responsible for the RIA
Socio-demographic questionnaires
The interviews were coded according to the following themes:
Definition of RIA
Implementation context
Implementation objectives
Composition of the RIA
How the RIA works
Benefits of RIA
Implementation strategies
Facilitating implantation
Obstacles to implementation
2. To carry out the single case study, we used:
One-on-one interviews with physicians, managers and nurses
Online survey with nurses and respiratory therapists
Socio-demographic questionnaires
The data were coded according to the following themes:
.jpg)
Management process for clinical deterioration
Signs and symptoms of clinical deterioration
Management of clinical deterioration
Role of stakeholders
Management strategies
Facilitating care
Barriers to care
Perception of RIA
Perception of RIA
Composition of the RIA
Perceived Effects of RIA
How the RIA works
Implementation methods
Implementation strategies
Strategies for improving care
1
Quebec rapid response team
(university hospital center in metropolitan area)
2
In the process of being implemented
(university hospitals in the metropolitan area)
-The existing RIA models differ according to the human and financial resources of the establishments
-The strategies and methods of implementation vary from one establishment to another
What results have we had?
The environmental scan
8
Individual interviews
26
Respondents to the online questionnaire
-
The management of the clinical deterioration involves the assessment of the nurse who then notifies the attending physician.
-
The composition of the RIA will depend on the likely call volume
-
There is no standardized strategy for the management of an unstable patient on general care units
-
EIR has positive impacts and is well perceived by respondents
-
The main obstacle to setting up is the lack of human resources
-
Categories of facilitators and obstacles to implementation:
-
health professionals
-
organization
-
training
-
research
-
-
The implementation strategies are; staff training, support for care teams and the organization, identification of the best structure for RIA, establishment of clear criteria and activation mechanisms, planning of sufficient resources, ensuring a rapid response from the RIA, implementation of a pilot project, continuous evaluation
The single case study
“I think that would decrease the stress level [...]. Instead of waiting for the patient to deteriorate to initiate a code blue, this team is the best way [...] to reduce the workload [...] and to treat the patient hastily in order to reduce the damage "
Intensive care nurse
