Rapid Response Teams: Needed? A sideshow?

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Is having a Rapid Response Team (RRTs) in place a smart move for a hospital, or is the hospital just ducking its responsibility to keep patients stable?  That’s an issue which has become white hot since a JAMA article came out suggesting that RRTs are, more or less, a sideshow that distracts from improving quality of care.

So, who’s right?  Maybe neither side. I’d argue that while this is an important issue, the dispute has left out an emerging approach which might affect the whole discussion.  More on this later.

This debate played out in an ABC News article, which outlines a study suggesting that RRTs are a Band-Aid solution.  The study, which appeared in the Journal of the American Medical Association, argued that RRTs are needed only because hospital beds are poorly managed.

The authors, Eugene Litvak of the Institute for Healthcare Optimization and Dr. Peter Provonost of Johns Hopkins University, are scathing critics of the RRT model. Why not ”throw patients in the parking lot, instead of providing a bed, and send the rapid response team,” Litvak told MedPage Today. “We would save even more lives because we would endanger more lives in the first place.”

Others, however, say RRTs are a great way to respond to crises and keep patients out of intensive care units.  (If so, that’s a big cost savings for insurers — whom, one would think, would be very much behind the idea — but none have spoken up this time.)  For example, at some of the Memorial Hermann Healthcare System’s largest hospitals, they have months without a single cardiac arrest on the floor, said Dr. M. Michael Shabot, chief medical officer for the Houston, TX chain.

Another data point in favor of RRTs:  As part of the Institute for Healthcare Improvements 100,000 Lives Campaign, 1,500 hospitals implemented RRTs, and rates of many negative outcomes (such as cardiac arrest rates, mortality rates and lengths of stay in the ICU) dropped.

What few debaters discuss, meanwhile, is a new way to use RRTs which might take the issue in a different direction.  Over the last few years, a small number of hospitals have begun letting families activate the RRT on their own.  The idea is that family members know the patient better than the clinician, and can tell when that patient is slipping more easily than an ED doctor who’s brand new to Patient X.

Perhaps taking the RRT and bending it into an instrument that responds to both existing crises and family concerns is worth considering.  What do you think?

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