It's 2:14 pm when critical care nurse Laurie Perkins’s beeper signals a Rapid Response Team call: An oncology patient in nine North Tower is losing consciousness, and the floor nurse is concerned.

By 2:19 Perkins and fellow RRT nurse Darry McSwain are at the bedside, bringing their critical care skills and ICU protocols to the floor. Working in synchrony, they assess the patient. They draw blood gas, order a chest x-ray, increase her oxygen, check her blood glucose level and intravenously administer D50-W, a sugar solution. This patient is their sole focus, and will be until she is stabilized or transferred to a higher level of care.

Perkins and McSwain are among 10 Rapid Response Team nurses, 2 per 12-hour shift. They respond to calls from floor nurses on adult units whose patients meet any of the Physiologic Instability Criteria, a trigger tool for early recognition of worsening condition. Sometimes the floor nurse says, “something just doesn’t look right,” and the RRT is off and running. Sometimes it’s a request to insert an IV on a fragile patient.

In effect, they’re an ICU SWAT team, bringing ICU-level care to adult patients, wherever they are in the hospital. They can begin critical care protocols beyond the purview of floor nurses, saving precious minutes of time for a patient in danger.

WFUBMC launched Rapid Response Teams in October 2004, after 10 months of planning. Now, Catherine Messick, MD, Early Detection and Intervention Committee chair, says the question is, “Why didn’t we think of this sooner?

“Having the Rapid Response nurses means there’s a whole range of interventions that we can provide sooner rather than later. We bring the critical care nurse to the patient and start the interventions right away. Then, when the patient is stable, we move them. It’s the opposite of how we used to do things. We don’t have to wait for an ICU bed, or for the floor to be mopped, or for a stretcher. It makes an enormous difference to be able to call a critical care-trained nurse who has no other floor responsibilities -- who can just focus on that one patient, wherever they are in the hospital, and do whatever needs to be done. That is powerful.”

Hospital data shows that the approach works.

“Codes,” situations in which a patient is rapidly deteriorating, experiencing cardiac or respiratory arrest, have decreased outside of the ICU significantly: by 60%, says Ron Small, vice president for Quality Outcomes.

Where there used to be a code per day on Medical-Surgical Units, now there are only about 8 per month, says Becky Petree, RN, a nursing operations director who oversees the Rapid Response Teams.

Each day the team receives about 8 calls from adult medical/surgical units for their critical care expertise, calls that typically each require a couple of hours. About 30% of the calls are in response to respiratory distress. The teams can administer selected medications not normally given outside of the ICU or increase oxygen up to a certain level without physician order, or give nebulizer treatments that normally require the respiratory therapist’s presence. They also function as consultants for floor nurses, and as on-site educators. About 50% of the patients treated by the RRT nurses are transferred to a higher level of care (acute, intermediate and critical care).

Ron Small sees Rapid Response Teams as having the greatest potential to improve outcomes of any of the Medical Center’s quality initiatives. “The Rapid Response Team is helping nurses recognize and act on the signs of patient deterioration early, rather than waiting until it might be too late. More people are surviving codes now because they are happening in the ICU, where there’s a full team trained for this kind of care.”

Indeed, the Medical Center has seen a significant improvement in its mortality index with a trendline showing steady decrease over the 2 years Rapid Response has been inaction, and now a leveling off.

“We are much ahead of other hospitals in implementing and refining this approach,” says Messick. “In 2005, when IHI identified Rapid Response Teams as an important mechanism to save lives, we were well on our way with our program. We now have a systematic way to bring resources to the patient for more intensive monitoring and treatment, wherever that patient is. We’re providing earlier, better care. As a physician, I think this is one of the best things this hospital has ever done.”

Excerpted from Visions Magazine, Spring 2007, by Annette Wilkerson Porter