Rapid Response Team

I work in a small rural hospital (

We are currently struggling with the same question. I took some RRT info to our Patient Safety Committee (mostly comprised of Nursing and other Clinical leaders) to discuss how we will implement such a team. We are looking at a simple team of an ICU nurse and a Respiratory Therapist as there is always one of each in house as well as a RN House Supervisor. We will most likely be implementing RRT in the next 3-6 months :innerconf

Ours is an ICU nurse, respiratory therapist, House Supervisor. 24/7. They carry beepers. When called, only the room number will show so no one has to call back. Just get there! Also, some code numbers for areas other than patient rooms.

We feel this team has been responsible for saving lives. Also it has helped other staffers because they learn while watching/assisting the team.

Go to the IHI website. We took pretty much all of our info from there. We have the ICU charge RN, Resident MD on call, Lead Resp Therapist, EKG tech respond. It goes well, and when we get there if the problem is easy, the resident on call handles it and we all go away. The quality office was largely involved with the development, several meetings with managers, MDs, Respiratory therapy. We developed criteria for calling, a form for the bedside RN to complete, etc. The IHI website actually has a handbook for starting RRTs. The site is IHI.org Good luck

I always smile when I see a post with someone who works in a "small rural hospital" and the bed capacity is 30 or plus. I also work at a small rural hospital, but we have one in patient floor with the capacity for 16 -18 beds. A while ago we implemented the Rapid Intervention Team (RIT), the same concept as the Rapid Response Team hype that's all the buzz now.

We do not have Respiratory in house 24 hours (and they don't intubate, only the physicians do) but the basic set up goes like this:

A person requiring activation of the RIT, has been defined as a rapidly detiorating person/patient, or one that may require the use of emergency equipment. To activate the team, where ever the situation has occurred, the page is made overhead (by the department/person, etc.) as "RIT" and then the location. To help differeniate (sp?) the deteriorating / unconcious person, from the the true Code Blue, overhead page would be made as "RIT Code Blue" and again the location.

We have a standard team set up that is the same for days and nights. The team consist of :

2 ER staff ( preferably the ER physician and nurse, but it may be the nurse and tech, the doc and tech, depending on what is happening in the ER, but all must be ACLS certified including the tech)

1 ACLS certified nurse from the Med Surg unit ( our in- patient unit )

1 BLS certified CNA from the Med Surg unit

1 Respiratory staff (if they are there at that time. Otherwise, they would be called in if necessary).

On our night shift, we have 1 ER doc, 1 ER tech, 1 ER nurse, so should a RIT be called, the ER nurse (who is also the night shift supervisor) may designate another appropriate person to go in his/her place if necessary, and would call the on call ER nurse in to cover the ER during this time.

Daily RIT assignments are made and posted on each department's monthly schedule. In addition to that, I have them posted on the daily staffing / patient assignment sheet as well.

There have been challanges and I've only shared the bare bones of it, but I'm more than happy to provide a copy of our policy to anyone or answer any questions you might have with starting a team up.

Hope this helps!

I would like to suggest that an ER 'tech' be utilized in a smaller hospital in addition to the ICU/ER RN. I know in my area the hospitals use nationally registered paramedics as their techs. If that is the case with you then it might also be helpful to find out what they are allowed to do vs what they are trained to do. I know here we become IV techs, we loose the authorization to intubate, use surgical airway techniques, and many other things that might be useful.

EMT/Paramedics are a wonderful resource. Our RRT has protocols approved by the medical staff which they may initiate after an RN assessment. But the tech's are valuable assets to the team.

How did you get your protocols in place?

when i worked in the hospital, our RRT consisted of (same for nights and days):

ER doc

ER nurse

ER tech (must be ACLS certified--which is why a paramedic is a great asset if i do say so myself :) )

ICU nurse

Tele nurse

Resp. therapist

Security because we had the lovely policy of family members activating the RRT and sometimes they got excited and called because nurse so and so didnt give nana her laxative today and she is constipated

CNA from float pool (must be BCLS certified)

we had a log book for the ER and i think ICU and tele did also of who was going to be on the RRT for that shift and it just rotated through the staff each day

our ICU nurse did some research on the topic and created a PowerPoint with evidence based information that was presented to the Medical Staff. Protocols were then approved and a policy was written. We decreased the number of codes called in our facility by 80% the first year.

when i worked in the hospital, our RRT consisted of (same for nights and days):

ER doc

ER nurse

ER tech (must be ACLS certified--which is why a paramedic is a great asset if i do say so myself :) )

ICU nurse

Tele nurse

Resp. therapist

Security because we had the lovely policy of family members activating the RRT and sometimes they got excited and called because nurse so and so didnt give nana her laxative today and she is constipated

CNA from float pool (must be BCLS certified)

we had a log book for the ER and i think ICU and tele did also of who was going to be on the RRT for that shift and it just rotated through the staff each day

That's a LOT of people in one room.

The purpose for the RRT team is to get your experience at the bedside and I know on my night shift it is VERY green! We are in a 130 bed hospital with ave census of 90-95 and have resp therapist and nursing supervisor 24 hours a day. We have those two along with a ICU nurse respond to our RRT calls. Our first difficulties that we had to overcome were

1. Staff not wanting to call it for fear of looking stupid and being sure those who responded did not question or chide staff for calling it. We set the expecation right away that it was a learning expereince and giving anyone a hard time about calling it would not be tolerated.

2. People wanted to turn it into a code team. It is not a code team it is a team to help identify and address a situation before it becomes the code. We had to teach our ICU staff and supervisors to help and teach, not to take over. Otherwise the less experienced staff never learn how to recognize or handle the situation if they encounter it again.

Once we got those areas addressed we saw a HUGE decrease in codes outside of ER and ICU, or mortality dropped significantly and my new grad nurses are so much more comfortable and are learning more then trying to figure it out on their own.