A recent study out of the University of Iowa’s Carver College of Medicine looked at how rapid response teams (RRTs) performed during an in-hospital cardiac arrest (IHCA) at top hospitals.
Ultimately, hospitals with dedicated RRTs and autonomous power had the best results. RRTs are essential in hospital emergencies, but to date there is little research on the differences between these teams at top-performing and other hospitals for IHCA care.
Hospitals that were consistently in the top 25% (based on survival for IHCA) were defined as top-performing hospitals.
For this study, published in JAMA Internal Medicine, researchers visited nine hospitals, all participants in the Get With The Guidelines-Resuscitation program during the years 2012 through 2014. On-site interviews were also conducted between April 2016 and July 2017.
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"Prior studies have highlighted differences in design and function of rapid response teams. However, our study is the first to link these differences with patient outcomes," co-author Saket Girotra, M.D., assistant professor of internal medicine at the University of Iowa, told FierceHealthcare. "While not altogether surprising, our findings reaffirm that differences in how a rapid response team is designed and implemented can impact patient outcomes. Identifying best practices could have an enormous impact on strengthening rapid response teams and improve patient safety across hospitals."
At top-performing hospitals, RRTs were frequently dedicated team members who did not have competing clinical responsibilities. This staff provided expertise to bedside nurses in managing patients who were at risk for deterioration and collaborated with nurses during and after a rapid response. In addition, bedside nurses were given the power to activate RRTs without fear of reprisal from physicians or other staff members.
In contrast, RRT members at non-top-performing hospitals had competing clinical responsibilities and were less communicative with bedside nurses. These teams were also more fearful of potential consequences for activating the RRT. The study concludes that top-performing hospitals featured dedicated RRTs that work collaboratively with bedside nurses and can be activated without fear of reprisal.
Co-author Kimberly Dukes from the Boston University School of Public Health noted that by using the example of top-performing hospitals, the research team shed further light on how RRTs are organized at the “best” hospitals for cardiac arrest care.
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"However, our study only included nine hospitals and, therefore, needs confirmation in other settings including hospitals with fewer resources," Dukes said. "Once validated, broad implementation of best practices of rapid response teams will need to occur in the context of each hospital’s local environment and resources. If successful, our work could potentially strengthen rapid response teams and improve patient safety across U.S. hospitals."
Co-author Jacinda Bunch from the University of Iowa School of Nursing agreed that further research was needed. While rich data on rapid response teams were collected, the primary focus of this particular study was on resuscitation or code blue teams.
"Based on findings from this paper, we believe that a focused study of rapid response teams would be highly informative in understanding best practices for rapid response teams," Bunch said.