Rescue me: saving the vulnerable non-ICU patient population

Area of Science:

• Hospital quality improvement
• Patient safety initiatives
• Critical care nursing

Background:

• Pre-implementation review revealed significant deficits in non-ICU patient care, with 75% experiencing arrest due to knowledge/judgment issues.
• Nearly half of all arrests occurred outside the ICU, resulting in a 60% mortality rate.
• High monthly transfer rates (96 patients) from floor units to the ICU were observed.

Purpose of the Study:

• To reduce the incidence and mortality of non-ICU arrests.
• To decrease unplanned ICU transfers from floor units.
• To provide critical care nursing for high-risk emergency department patients.

Main Methods:

• A multidisciplinary team developed a nurse-driven rapid response team (RRT) protocol and data collection system over 12 months.
• 4.2 FTE RRT nurse positions were established through unit contributions.
• The RRT implemented a structured methodology for patient assessments and interventions.

Main Results:

• Floor codes decreased from 36 to 17 per year, with a mortality rate drop from 61% to 26%.
• RRT calls averaged 118 per 1,000 discharges, with 138 calls monthly supporting the ED.
• Significant reduction in unanticipated floor-to-ICU transfers was achieved.

Conclusions:

• The RRT initiative demonstrated measurable success in protecting vulnerable hospitalized patients.
• The program facilitated the identification of system and clinical issues, leading to process improvements.
• At-risk patient subpopulations, such as those with heart failure or on high-dose narcotics, were identified for targeted care.