I've been talking with a few people at my hospital about my intention to collect time-interval data from codes, and they have wanted to know if I'm involved with the Rapid Response Team. I'm not, at least so far. The RRT is a new thing at my hospital; I think it is the same idea that is more commonly referred to in the professional literature as a "medical emergency team"As I understand the concept, it’s essentially an emergency response team available around the clock for support and consultation for patients whose condition is worsening--comprising a staff physician, a couple of critical care nurses, a respiratory therapist, etc. The big idea is to be proactive (faddish but useful word), getting on top of problems before they deteriorate to the point that a code occurs.
One doctor who is involved in the RRTs was especially enthusiastic about the concept and went so far as to mention the goal of making code teams "obsolete." My initial (unspoken) reaction to this was that it would never happen. I'm only vaguely aware of the literature on medical emergency teams, but I maintain that even assuming perfect vigilance (which of course is far from reality), totally unexpected arrests will occur in hospitals--just as they do outside, and probably with greater frequency. But then why am I of all people reflexively assuming that this means code teams are needed? Maybe the combination of an effective nurse defibrillation program and the medical emergency team concept makes sense.
I'm not very clear how paging the RRT at my hospital differs from paging a code, but I think that it involves an immediate phone response from one team member, maybe an ICU nurse, to evaluate the nature and urgency of the call and make a decision about whether/when to mobilize the rest of the team. Would this be sufficient for a code on a unit without cardiac monitoring, assuming defibrillation has taken place at the local level if indicated? One could maintain that the big event—determining whether the dysrhythmia is shockable and shocking if necessary—has already occurred at the time of the call, so that any further response needn’t be in super-crisis or “heroic” mode.
