Iowa researchers identify commonalities among effective rapid response teams

Rapid response teams (RRTs) are highly specialized hospital emergency teams that treat patients who develop a sudden worsening of their clinical condition, which if not treated can be life-threatening. However, prior studies of the effectiveness of RRTs have shown varied results, leading some to suggest these teams are irrelevant, while others have argued they are essential for patients who need immediate attention. In the midst of this debate, a new study, conducted by researchers at the University of Iowa and other institutions, examined how top-performing hospitals implement RRTs and identified ways teams could be potentially strengthened.

Their study published in the Journal of the American Medical Association (JAMA) Internal Medicine found that top-performing hospitals have rapid response teams that are fully committed to serving patients that need immediate care without competing responsibilities. Kimberly Dukes, PhD, research assistant professor in General Internal Medicine, Jacinda Bunch, PhD, RN, assistant professor in the College of Nursing (co-first authors), and senior author Saket Girotra, MBBS, SM, assistant professor in Cardiovascular Medicine, revealed further distinct patterns of collaboration at top-performing hospitals.

The researchers used data from HEROIC (Hospital Enhancement of Resuscitation Outcomes for In-hospital Cardiac Arrest), an ongoing mixed methods study of resuscitation practices at US hospitals. Girotra said, “By using the example of top-performing hospitals for cardiac arrest care, we shed further light on how rapid response teams are organized at the ‘best hospitals’ for cardiac arrest care.” The researchers compared the organizational structure and function of RRTs across hospitals with varying levels of performance on in-hospital cardiac arrest survival.

The study also used qualitative interviews with 158 healthcare providers from nine hospitals participating in the American Heart Association’s Get With The Guidelines-Resuscitation program to identify the possible areas of differences between top-performing and non-top-performing hospitals.

“These differences are important to understand because previous studies on the effectiveness of rapid response teams have been mixed,” Dukes said. “Some have suggested a benefit while others have not. This may be because a rapid response team is a complex, multidisciplinary intervention, and may be designed and implemented differently in different sites.”

Bunch said their paper ultimately highlights four broad patterns besides ensuring RRTs had a singular focus. Top-performing hospitals, Bunch said, had RRTs that “partnered closely with bedside nurses in managing complex patients before, during, and after a rapid response. We also found that bedside nurses felt empowered to activate a rapid response based on their judgement and experience, without fear of reprisal.”

The team from the University of Iowa collaborated closely with investigators from the University of Michigan and the Mid America Heart Institute in Kansas City, Missouri. Data for this study was derived from the HEROIC study funded by the NHLBI (PIs Brahmajee Nallamothu, MD, MPH, professor of medicine at the University of Michigan; and Paul Chan, MD, cardiologist at the Mid America Heart Institute and professor of medicine at University of Missouri-Kansas City).

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