Refining the program theory of the nurse-led Rapid Response Team in acute care hospitals: A realist evaluation

Caring for unstable patients in a general ward is a challenging task for nurses and impacts patients' safety. To assist nurses in detecting and managing patient deterioration, the nurse-led Rapid Response Team has been implemented worldwide for over 25 years with divergent results regarding reduced patient mortality, cardiac arrest rates, and admissions for intensive care. To develop new initiatives targeting well-documented challenges embedded in using the nurse-led Rapid Response Team, research-based knowledge from a broader perspective on the Rapid Response Team is crucial. This study evaluated how and for whom the nurse-led Rapid Response Team works.

To test initial and alternative program theories of the nurse-led Rapid Response Team in acute care hospitals and further refine the program theories of this complex health care intervention.

A realist evaluation.

A four-stage cycle process was applied, involving a synthesis of literature of the Rapid Response Team published between 2014-24, and empirical data from six qualitative studies, serving as analytical tools. To explore multiple stakeholders' perceptions of the Rapid Response Team a variety of data-collection methods including participant observations, focus group interviews, and individual interviews were used in the qualitative studies. Intensive care and general ward nurses, physicians in clinical and coordinating roles, and multiple hospital managers across various levels at three acute care hospital in three Danish regions were involved in the six qualitative studies.

The fourth stage of the realist evaluation resulted in a refined program theory stating, "If Rapid Response Team-nurses use their intensive care skills and competences and collaborate amiably, creating a respectful and calm atmosphere whilst also capturing the needs of both nurses and patients, then the role as a Rapid Response Team-nurse is fulfilled and responsibility between the involved parties is shared. General ward nurses will then choose to call the team for assistance and Rapid Response Team-nurses will choose to engage in future Rapid Response Team calls, which will subsequently lead to clinical actions being taken, patients being helped, and general ward nurses feeling secure whilst also learning new skills".

The nurse-led Rapid Response Team is perceived to work for patients, general ward nurses, Rapid Response Team-nurses, and the organization, due to Rapid Response Team-nurses' skills, the respect between nurses, and the essential collaboration inherent in intra-professional nursing teamwork across nursing positions and working areas. The primary responsibility for this collaboration lies with the individual Rapid Response Team-nurse and the Rapid Response Team-coordinator.