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Certain factors drive success of rapid response teams

Sunday May 12, 2013
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Clinical expertise is paramount to a rapid response teamís effectiveness, but strong teamwork and good communication among multidisciplinary members are critical for optimal patient safety, according to a study.

Rapid response teams are mobile groups of clinicians with critical care expertise that respond quickly to a bedside nurseís request for assistance with a patient whose condition might be worsening. The team typically includes a RN, respiratory therapist and physician, all of whom are on call throughout their shifts to respond within five minutes to RRT requests.

RRTs are a common patient safety initiative to reduce adverse events and prevent avoidable deaths among hospitalized patients, but research into how RRTs function as a team has been limited, according to background information in the study, which is published in the May issue of the American Journal of Critical Care.

The study, "Rapid Response Teams: Qualitative Analysis of Their Effectiveness," documents elements related to team effectiveness from multiple perspectives within RRTs. By exploring team structure, organizational culture, expertise, communication and teamwork, research findings indicate that teamwork and communication are essential elements of a successful team.

"Individual highly skilled clinicians need to be able to quickly come together as a team to provide optimum care to the patient at a critical point in their care," Linda Searle Leach, RN, PhD, NEA-BC, CNL, a study leader and assistant professor in the UCLA School of Nursing, said in a news release.

"Team-based care delivery is not an optional approach in the quest to achieve safe and reliable care for every patient, every time; it is an imperative."

The researchers found RRTs functioned well at managing patients at risk or in crisis, but the RRT structure poses unique teamwork and communication challenges. The day-to-day fluidity of team members limits opportunities to develop relationships or team skills. In addition, the clearly defined leadership role that nurses play within RRTs demands a level of collaboration among nurses and physicians that facilitates shared leadership in patient care, the study shows.

RRT training — as with training for many other teams in healthcare settings — does not address interpersonal communication, collaboration and teamwork, according to the study. Due to their structure, RRTs may need this type of training more than teams that work together regularly and under less time pressure, the researchers concluded.

Future training needs identified by study participants include a focus on communication; using simulation; and bringing individual nurses, physicians and respiratory therapists together to interact as a team in a non-urgent setting or simulated rapid response situations. Multidisciplinary training that focuses on communication, collaboration and a team orientation was recognized as necessary for effective RRT performance.

The study includes information about the benefits of debriefing as a team immediately after an intervention, describing the process as highly informative and useful for performance evaluation and team learning.

Healthcare leaders should examine how RRT members work together as a team and recognize that teamwork strongly influences performance, according to the researchers.

Leach and co-lead investigator Ann M. Mayo, RN, DNSc, professor in the Hahn School of Nursing and Health Science at the University of San Diego, conducted in-depth interviews with individual RRT members and observed teams in action to collect data for their analysis. The research was sponsored by the Association of California Nurse Leaders and was funded by the Gordon and Betty Moore Foundation and the UCLA School of Nursing.

Read the study: http://ajcc.aacnjournals.org/content/22/3/198.full.


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