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Original Investigation
July 29, 2019

Assessment of Rapid Response Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest

Author Affiliations
  • 1Institute of Clinical and Translational Science, University of Iowa, Iowa City
  • 2College of Nursing, University of Iowa, Iowa City
  • 3Department of Internal Medicine, University of Missouri–Kansas City
  • 4Division of Cardiology, Department of Internal Medicine, University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City
  • 5Department of Family Medicine, University of Michigan Medical School, Ann Arbor
  • 6Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 7Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 8Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
  • 9Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
  • 10Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
  • 11Division of Cardiovascular Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
JAMA Intern Med. 2019;179(10):1398-1405. doi:10.1001/jamainternmed.2019.2420
Key Points

Question  How do rapid response teams differ between top-performing and non–top-performing hospitals for resuscitation care?

Findings  In this qualitative study of data collected from interviews with 158 key stakeholders at 9 Get With The Guidelines–Resuscitation hospitals, distinct differences were found in the organizational structure and function of rapid response teams. Top-performing hospitals feature rapid response teams with dedicated staff without competing responsibilities, serve as a resource for bedside nurses in surveillance of at-risk patients, collaborate with nurses during and after a rapid response, and can be activated by a member of the care team without fear of reprisal.

Meaning  This study appears to provide important insights regarding strengthening rapid response teams across hospitals.

Abstract

Importance  Rapid response teams (RRTs) are foundational to hospital response to deteriorating conditions of patients. However, little is known about differences in RRT organization and function across top-performing and non–top-performing hospitals for in-hospital cardiac arrest (IHCA) care.

Objective  To evaluate differences in design and implementation of RRTs at top-performing and non–top-performing sites for survival of IHCA, which is known to be associated with hospital performance on IHCA incidence.

Design, Setting, and Participants  A qualitative analysis was performed of data from semistructured interviews of 158 hospital staff members (nurses, physicians, administrators, and staff) during site visits to 9 hospitals participating in the Get With The Guidelines–Resuscitation program and consistently ranked in the top, middle, and bottom quartiles for IHCA survival during 2012-2014. Site visits were conducted from April 19, 2016, to July 27, 2017. Data analysis was completed in January 2019.

Main Outcomes and Measures  Semistructured in-depth interviews were performed and thematic analysis was conducted on strategies for IHCA prevention, including RRT roles and responsibilities.

Results  Of the 158 participants, 72 were nurses (45.6%), 27 physicians (17.1%), 27 clinical staff (17.1%), and 32 administrators (20.3%). Between 12 and 30 people at each hospital participated in interviews. Differences in RRTs at top-performing and non–top-performing sites were found in the following 4 domains: team design and composition, RRT engagement in surveillance of at-risk patients, empowerment of bedside nurses to activate the RRT, and collaboration with bedside nurses during and after a rapid response. At top-performing hospitals, RRTs were typically staffed with dedicated team members without competing clinical responsibilities, who provided expertise to bedside nurses in managing patients who were at risk for deterioration, and collaborated with nurses during and after a rapid response. Bedside nurses were empowered to activate RRTs based on their judgment and experience without fear of reprisal from physicians or hospital staff. In contrast, RRT members at non–top-performing hospitals had competing clinical responsibilities and were generally less engaged with bedside nurses. Nurses at non–top-performing hospitals reported concerns about potential consequences from activating the RRT.

Conclusions and Relevance  This qualitative study’s findings suggest that top-performing hospitals feature RRTs with dedicated staff without competing clinical responsibilities, that work collaboratively with bedside nurses, and that can be activated without fear of reprisal. These findings provide unique insights into RRTs at hospitals with better IHCA outcomes.

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