Rapid Response Team (RRT) in a supraregional hospital context: an environmental scanand 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 (RRTs) are a strategy to improve the safety of hospitalized patients whose clinical condition is deteriorating. They are present in most hospitals in Australia, North America and the United Kingdom and their use continues to spread throughout the world.

An RRT is a team made up of healthcare professionals with expertise in critical care, which goes to the bedside of a patient presenting criteria of physiological instability at the request of the team in charge of the care unit.  

Before setting up such a team in a supraregional hospital centre, it seems essential 1) to profile the acceptability, implementation and impact of RRTs in Quebec and 2) to explore the needs of healthcare teams of the center with regard to the RRTs and 3) the terms of a future implementation.

What are our goals?

1) Describe the current composition and methods of setting up RRTs on Quebec territory

2) Describe the needs of the care teams of the supraregional hospital center with regard to RRTs

3) Describe the needs of the care teams of the supraregional hospital center with regard to the terms of a future implementation

How?

This research project is divided into two phases: 1) an environmental scan and 2) a unique case study.

 

The environmental scan made it possible to review current practices in Quebec hospitals with regard to RRTs. The unique case study made it possible to describe the needs of the care teams of the supraregional hospital center with regard to the RRTs and the modalities of a future implementation in the particular context of the care of a patient whose clinical condition is deteriorating. . Before exploring the healthcare teams' perception of RRT, 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 hospitals in Quebec 

  • Individual interviews with the responsible person
    of the RIA

  • Sociodemographic questionnaires

 

The interviews were coded according to the following themes:

  • Definition of RRT

  • Implementation context

  • Implementation objectives

  • Composition of the RIA

  • How the RIA works

  • Benefits of RIA

  • Implementation strategies

  • Implementation facilitators

  • Barriers to implementation

 

2.To carry out the unique case study, we used:

  • Individual interviews with doctors, managers and nurses

  • Online survey with nurses and respiratory therapists

  • Socio-demographic questionnaires

 

The data was coded according to the following themes:

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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

Clinical deterioration management process

  • Signs and symptoms of clinical deterioration

  • Management of clinical deterioration

  • Role of stakeholders

  • Support strategies

  • Support facilitators

  • 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 Support

What results have we obtained?

The environmental scan

1

Quebec Rapid Response Team

(university hospital center
in metropolitan area)

2

In the process of being
implemented (university hospitals
in metropolitan areas)

image 1 véro.png

-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

The single case study

8

Individual interviews

26

Respondents to the online questionnaire

  • The management of clinical deterioration goes through the evaluation of the nurse who then notifies the attending physician

  • The composition of the RRT will depend on the likely call volume

  • There is no standardized strategy for managing an unstable patient on general care units.

  • EIR has positive impacts and is well perceived by respondents

  • The main obstacle to implementation is the lack of human resources

VeroDauwe_Schéma intégrateur2.1.png

  • Categories of facilitators and obstacles to implementation: 

    • health professionals

    • organization

    • training

    •  recherche

  • The implementation strategies are; training of staff, support of care teams and the organization, identification of the best structure for RRT, 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.