The Effects of Recruiting a Provider to the RRT Team as it Correlates to Delayed Care in Hospitalized Medical Patients

As the population in the United States continues to expand, the baby boomers population is growing older which has a prominent role in the drastic shortage of nurses as well as the number of Americans who suffer from a variety of chronic diseases and illnesses. Some of these illnesses and medical conditions include hypertension, diabetes, cancer, and chronic lung conditions which have led to increased hospitalizations each year. Morton and his colleagues proclaim that hospitalization alone contributes to a decline in the patients’ condition (Morton et al., 2007). In addition, Leach and Mayo demonstrate the fears associated with patient safety in U.S. hospitals which has sparked national safety initiatives in an effort to contain undesirable, tragic events (Leach & Mayo, 2013). It is therefore imperative to safeguard the health of the U.S. population with access to exceptional quality provider healthcare as well as quality and process improvements thereby preventing disconcerting delays in care and treatment intervention within a hospital setting. The purpose of this paper is to introduce an evidence-based practice (EBP) change initiative that will primarily focus on prompt provider assessment and interventions following the identification of condition decline in patients hospitalized in the medical unit.

Background

Since hospitals with an inadequate number of health care providers is a common occurrence within health care organizations today, overburdened providers proclaim that patients experience longer wait times along with a heightened incidence of adverse events. This results in an increase in mortality and morbidity rates. The excess workload providers encounter stem from physician shortages which accounts for nearly 12 months of vacancies for some hospitals (Szabo, 2010). Ninety-three percent of hospital RNs reported major problems with having an inadequate amount of time to maintain patient safety and detect complications early (Buerhaus et al., 2005). Delays in nurse responses occur because there is an insufficient number of providers administering care due to understaffing issues (Buerhaus et al., 2005). The Institute for Healthcare Improvement launched a 100,000 Lives Campaign in 2004 to encourage American hospitals to implement lifesaving strategies that provide rapid assessment and treatment interventions such as rapid response teams (RRT) (Thomas et al., 2007). Young and his colleagues demonstrate an increase in patient mortality rates with clinical intervention delays from medical and surgical wards to intensive care units (ICU) due to further recognition of deteriorating physiological conditions (Young et al., 2003). The failure of clinical providers to respond and take appropriate action in a timely manner in patients hospitalized in medical units is a clinical problem that can ultimately lead to cardiac and respiratory arrests (Resuscitation Central, 2010). A study conducted in a local hospital in Arizona reported significant delays in treatment to be greater than 4 hours, which have been attributed to adverse respiratory conditions (Halter et al., 2009). Respiratory and cardiac arrests usually occur in hospitals due to a delay in the administration of care. These injuries present a serious concern due to the development of detrimental disease, illness, and potentially death which must, therefore, be appropriately addressed.

Significance

According to a study conducted by Barbetti and Lee (2008), care-related delays are attributed to 48% of mortality rates making this a significant clinical problem. Furthermore, out of these deaths, 54% were identified as preventable (Barbetti & Lee, 2008). Subsequent delay in treatment causing cardiac arrests have proven to be preventable since 1990 (Subbe & Welch, 2013). After examining and analyzing the high percentage of mortality due to delays in treatment it is clear to state that this is a major problem and must be addressed in order to save lives.

Hospital costs associated with a delay in care of patients to the ICU were estimated to be $34,000 as compared to $21,000 for patients who receive response and treatment within a timely manner making this a significant problem in clinical practice (Young et al., 2003). Patients that are unexpectedly transferred to the ICU incur increased hospital length of stays (LOS) which correlates to increased costs. Hospitals will be able to save an estimated $171,000 through the provision of improved quality of care and a reduction of a patients’ length of stay (Thomas et al., 2007). Since delays in care are associated with increased mortality rates especially involving deaths from preventable illnesses and increased hospital length of stays, an intervention is needed to address the decline of adult medical-surgical patients whose physiological conditions are subsequently declining in medical units.

PICO Question

Hospitals can improve their respective quality of care through the effective and efficient use of evidence-based practice. EBP is categorized as “the integrated consideration of patient preferences, sound clinical judgment of nurses, best research evidence, and health care context” (Chin & Kramer, 2011). However, the most widely used definition of EBP entails “the conscientious, judicious, and explicit use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 1996, p. 71). The success of EBP is based on a well-organized inquiry consisting of the Problem/Population, Intervention, Comparison, and Outcome (PICO) framework.

This writer will pose the question utilizing the PICO format in order to narrow the search of data and information: In adult medical-surgical patients whose physiological conditions are declining in medical units, how does the recruitment and retention of a provider for the RRT affect mortality rates? This writer will introduce a pilot study within a local community hospital and attempt to amend the organizational culture of the rapid response team by including a provider on the team to deliver rapid intervention following the team activation. The literature supports the identification and rapid provider intervention thereby reducing the mortality rate for many other adverse events.

Description of PICO Components

The participant population will include all patients admitted to medical units within a hospital setting. The sample for this project will consist of adult patients both male and female who are 18 years of age or older who have experienced a decline in their condition which resulted in the activation of the rapid response team. The intervention intended for this project will consist of an adjustment to the RRT team. The project will perform a retrospective chart review to compare those patients who received RRT’s with and without a provider. The information collected will be used to assess the intervention’s effectiveness and efficiency. The overall planned results include concepts such as decreased mortality, reduced unplanned ICU transfers, increased patient satisfaction, reduced hospital costs related to increased LOS, and staff satisfaction.

Conclusion

Failure to respond to rapidly deteriorating patients in medical units result in increased hospital mortality rates and costs generated from resuscitation efforts and increased LOS. The proposed evidence-based project intervention will address the delayed care of hospitalized patients, which will be beneficial to all parties involved. First, the decrease in patient mortality will result in favorable outcomes for patients. Secondly, decreasing hospital costs by keeping the patient in medical units with early diagnosis and intervention would be beneficial to the hospital as it relates to a decrease in hospital costs and heightened patient satisfaction.

References

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Buerhaus, P.I., Donelan, K., Ulrich, B.T., & Norman, L. (2005). Hospital RNs’ and CNOs’ perceptions of the impact of the nursing shortage on the quality of care. Nursing Economics, 23(5), 214-21.

Hatler, C., Mast, D., Bedker, D., Johnson, R., Corderella, J., Torres, J., King, D., & Plueger, M. (2009). Implementing a rapid response team to decrease emergencies outside the ICU: One hospital's experience. MEDSURG Nursing, 18(2), 84-126.

Leach, L., & Mayo, A. M. (2013). Rapid response teams: Qualitative analysis of their effectiveness. American Journal of Critical Care, 22(3), 198-210. doi:10.4037/ajcc2013990

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare (2nd ed.). Philadelphia, PA: Wolters Kluwer|Lippincott Williams & Wilkins.

Resuscitation Central. (2010). Rapid response and medical emergency teams. Retrieved from http://www.resuscitationcentral.com/documentation/rapid-response-medical-emergency-team/

Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence-based medicine: What it is and what it isn’t: It’s about integrating individual clinical expertise and the best external evidence. British Medical Journal, 3(12), 71–72.

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Subbe, C., & Welch, J. (2013). Failure to rescue: Using rapid response systems to improve care of the deteriorating patient in hospital. Clinical Risk, 19(1), 6-11. doi:10.1177/1356262213486451

Szabo, J. (2010). Physician shortage. Doctor vacancies pose severe problem for children's hospitals: subspecialists are in high demand, but the supply isn't keeping pace. Hospitals & Health Networks, 84(2), 12.

Thomas, K., Force, M.V., Rasmussen, D., Dodd, D., & Whildin, S. (2007). Rapid response team: Challenges, solutions, benefits. Critical Care Nurse, 27(1), 20-28.

Young, M.P., Gooder, V.J., McBride, K., James, B., & Fisher, E.S. (2003). Inpatient transfers to the intensive care unit: Delays are associated with increased mortality and morbidity. Journal of General Internal Medicine, 18(2), 77-83.