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.
3 comments:
Bookmarked this. Show one's gratitude you for sharing. Positively worth my time.
This is a celebrated article as they all are. I have been wondering less this for some measure now. Its notable to grow this info. You are reasonable and balanced.
I am a part of a RRT or MET team and you are actually going too far with how you think of it. Do I agree with your doc that it will make the code team disappear? Not at all. But at the same time that ICU nurse you are talking about gets called for many more things than just to analyze a rhythm and decide to defib before calling the rest of the team.
Here we have a whole set of criteria to call on our team. It is more of a deteriorating patient than a precode patient. We call the MET team for things such as low O2 sats or low BP, bradycardia with symptoms, tachycardia, suspected acute stroke etc. Things that can be fixed or at least delt with before it leads to a code situation where that ICU nurse has to decide whether to defib or not.
Hope this helps you understand what these teams are for!!
Tracey
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