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Westchester’s Rapid Response Team Improves Patient Outcomes

Monday November 8, 2010
Westchester Medical Center nurse administrators are, standing from left, Mary McKiernan, RN, vice president, nursing education and quality; Eileen P. Williamson, RN, senior vice president, Nursing Communications & Initiatives, Nursing Spectrum; and Margaret Perreira, RN, senior vice president and interim CNO. Seated from left, are Cathy Spratt, RN, vice president, patient care services; Kathy Longo, RN, nurse manager, MICU and SICU; and Eileen Farrington, RN, clinical nurse specialist, transplant and critical care.
Westchester Medical Center nurse administrators are, standing from left, Mary McKiernan, RN, vice president, nursing education and quality; Eileen P. Williamson, RN, senior vice president, Nursing Communications & Initiatives, Nursing Spectrum; and Margaret Perreira, RN, senior vice president and interim CNO. Seated from left, are Cathy Spratt, RN, vice president, patient care services; Kathy Longo, RN, nurse manager, MICU and SICU; and Eileen Farrington, RN, clinical nurse specialist, transplant and critical care.
(Photo by Janice Petrella Lynch, RN)
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By creating rapid response teams, nurses at Westchester Medical Center in Valhalla, N.Y., have capitalized on the fact that six to 18 hours before a cardiac arrest, patients may exhibit subtle signs and symptoms, called “triggers.” The initiative, originally a nurse manager project at the medical center, became a hospitalwide effort in January.

After months of work and research, the Rapid Response Steering Committee finalized the rapid response teams; each includes a critical care nurse, respiratory therapist, senior medical or surgical resident and the attending physician for that particular patient. RNs throughout the facility then were educated by the committee, with the help of the clinical nurse specialists and nurse managers, on the specific triggers, such as changes in mental status and consciousness, blood pressure, respiratory rate, heart rate, heart rhythm, body temperature, urinary output and seizure. With the backing of nursing and medical administration, staff were given protocol sheets, which include a trigger sheet listing changes in patient conditions that should prompt a rapid response call and an order-set sheet to document the rapid response event.

If nurses see any of these triggers or find themselves saying, “This patient just doesn’t look right,” they are instructed to immediately call the operator, who sets off the rapid response pager. Within minutes of the call, a rapid response team appears at the bedside to assess the patient and begin medical interventions quickly, if needed.

“Over the last two years, I have called a rapid response on several occasions, and I felt that I had immediate and real support as the patients’ conditions were rapidly declining,” said Maria Egan, RN, BSN, staff nurse on the transplant unit. “It was a team effort.”

ICU nurses are designated to cover similar units. For example, the MICU responds to calls from a medical unit and the SICU responds to calls on the surgical unit.

Separate from the code team, the rapid response unit is a nurse-helping-nurse collaborative, in which nurses who made the call and nurses who responded to it are formally thanked by the committee. “No call is ever considered a bad call, and we have created a real partnership between our med/surg and critical care nurses,” says Kathy Longo, RN, BSN, CNML, NE-BC, nurse manager, MICU and SICU. “Critical care nurses check back with the nurses and patients on the units, and the med/surg nurses feel free to ask the ICU nurses any questions.”

WMC successfully reached its goal, which was to offset the number of codes on the adult units. According to the Rapid Response Steering Committee’s quality management audits, since the initiation of the teams in January, the number of codes on the adult med/surg units are down by 50% to 60%; of the calls, only 33% of patients needed to be transferred to the ICUs, and there has been a reduction in the overall number of patient mortalities.

“The committee continues to meet weekly to obtain and review statistical data on the effectiveness of the team,” said Margaret Perreira, RN, BS, MBA, FACHE, senior vice president and interim CNO. “In addition, we have expanded the teams to cover the outpatient areas of the medical center, such as diagnostic radiology, nuclear medicine and MRI. Next we plan on developing and implementing a pediatric rapid response team in December.”


Janice Petrella Lynch, RN, MSN, is a regional reporter. Send letters to editorNJ@nursingspectrum.com or comment below.