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The role of the primary care team in the rapid response system
John C O'Horo1, Ronaldo A Sevilla Berrios1, Jennifer L Elmer2
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Purpose:
The purpose of the study is to evaluate the impact of primary service involvement on rapid response team (RRT) evaluations.
Materials And Methods:
The study is a combination of retrospective chart review and prospective survey-based evaluation. Data included when and where the activations occurred and the patient's code status, primary service, and ultimate disposition. These data were correlated with survey data from each event. A prospective survey evaluated the primary team's involvement in decision making and the overall subjective quality of the interaction with primary service through a visual analog scale.
Results:
We analyzed 4408 RRTs retrospectively and an additional 135 prospectively. The primary team's involvement by telephone or in person was associated with significantly more transfers to higher care levels in retrospective (P < .01) and prospective data sets. Code status was addressed more frequently in primary team involvement, with more frequent changes seen in the retrospective analysis (P = .01). Subjective ratings of communication by the RRT leader were significantly higher when the primary service was involved (P < .001).
Conclusions:
Active primary team involvement influences RRT activation processes of care. The RRT role should be an adjunct to, but not a substitute for, an engaged and present primary care team.
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