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:

Remue-méninges

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)

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-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

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“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

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