Response Team

Like many hospitals, mine has a Rapid Response team (RRT). Although they go by different names, they have a similar purpose: To provide complex and rapid medical support to a patient who is acutely decompensating but does not require resuscitation (yet). The goal of RRTs is to stabilize these patients and prevent the need for calling a Code Blue. At my workplace, patients and families can actually call for the RRT directly. I tell them at admission that it is akin to calling 911 from home – if there is a change in the patient’s condition, it is appropriate to call for help without having to wait for the nurse. Sometimes we are able to stabilize the patients with support from respiratory therapy and ICU staff. Sometimes Often we have to transfer the patients to a higher level of care. Sometimes we are forced to call RRTs because we are concerned about a patient but their attending doesn’t seem to be all that worried, and we want more eyes on the situation.

I’ve been lucky (or unlucky) enough not to have participated in many RRTs in my career. The good news is, I haven’t needed to. The bad news is, RRTs make me nervous because they can be very chaotic and unsettling to patients and families. Plus, as I’ve said before, critical care situations just aren’t for me.

When I have encountered patients requiring rapid response, I’ve often struggled with a decreased confidence in my own clinical judgment. I ask the typical questions: Could I have prevented this by doing XYZ? What did I miss? Is this my fault?

It’s hard not to beat up on ourselves when our patients need a level of care that we can’t provide. I have to stop and remind myself that whatever the cause, my patient will do better on a unit where his/her nurse does not have five other patients. I’m as vigilant as I can be, but sometimes it’s a question of patient safety.

Which makes me wonder… At a time when efficiency and cost-cutting are prioritized, are we compromising safety for the sake of dollars and cents? Or because it’s convenient? For example, we’ve had patients admitted to our unit because we are the oncology floor, even if they are not appropriate and should really be in the ICU. The oncologists have justified it by saying the patients will do better being cared for by oncology nurses. But these oncology nurses are also medical nurses with 5-6 patients on a typical shift, and we don’t have the staffing to provide the intensive level of care that some of our patients require. And just because a patient has cancer doesn’t mean we are the right caregivers – if they just had major surgery, or are critically ill, or have a fresh trach, they need (and deserve) more support than we can possibly provide.

As helpful as RRTs can be in preventing code situations, I worry that we rely on them too much. When I’ve tried to advocate for a patient transfer to step-down or ICU, I have been told by supervisors, physicians, and fellow nurses that it’s not possible now but I can “always call a rapid”! I understand that we work as a team and it’s okay to call for help, but shouldn’t we be trying to prevent these situations from happening in the first place? With staffing the way it is, will response teams become our new normal because patients are not receiving the care they need?

Falling back on mantra that we can always call a rapid feels a bit lackadaisical to me.

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