mybetterdoctor

Dear Riverton Team,

Happy Monday! I hope you are enjoying the stunning fall colors and weather. Last week I shared a bit about the types of interventions I’ve seen have greatest impact since I became a doctor and talked about low tidal volume ventilation and protocols have saved lives. Today I share another example of how early assessments improve outcomes, reaffirming the old adage about an ounce of prevention and a pound of cure.

Act II.

1. The Rapid Response Team (MET team/RRT)

In the “olden” days, bedside nurses in hospitals sometimes had patients that were getting sicker and sicker over the course of a day.  The nurses would recognize that these patients needed urgent (but not (yet) emergent) evaluation and treatment.  They called the physicians responsible for those patients.  Usually, patients were evaluated promptly and physicians responded. But at sometimes, physicians had other more urgent duties (such as operating or seeing other patients) and were delayed. Nurses felt helpless and frustrated. They kept paging, kept waiting, and occasionally, patients progressed to having cardiac arrest and a code blue was called.

As the pace of medicine has changed (weeks of bed rest as treatment for acute myocardial infarction vs. door to balloon times less than 90 minutes!), so too, our expectations and understanding of what one person can do at one time has evolved. In prior years, it was common for primary care physicians to pop over to the hospital to see their inpatients before returning to clinic to finish seeing their clinic patients. In current community hospital and academic medical center practice, we have hospitalists who specialize in seeing patients in the hospital while their colleagues in outpatient medicine focus on their clinic patients and outpatient care.

Similarly, the intensity and pace of care in our inpatients has changed.  It used to be that a nurse might recognize a patient who was getting worse and try to reach a doctor to intervene. Occasionally, there was significant delay in how quickly those doctors could come from another hospital, or the operating room or clinic to see the patient.  To try to help prevent these avoidable patient deteriorations, hospitals implemented rapid response teams or medical emergency teams.  These RRT or MET teams, as they came to be known, helped nurses, family members, or ANYONE call for help and urgent evaluation when they were concerned about a change in patient status.  A team would come and evaluate the patient and make appropriate treatment and care decisions and coordinate with the primary team.  In hospitals across the world, AND at RIVERTON Hospital, we have seen that an increase in RRT calls results in a decrease in code blues. Most of the time, patients who have a code blue are decompensating for hours before they code, AND having a culture of safety to allow for earlier assessment and treatment can prevent many of those cardiac arrests.

We certainly can improve how well we run the code, once it’s called, and teamwork and leadership remain important factors there.  AND we save more lives by using teamwork and leadership to PREVENT the code. And that is where we want to continue to make improvements.

1. Assessment of Rapid Response Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest | Cardiology | JAMA Internal Medicine | JAMA Network https://shmpublications.onlinelibrary.wiley.com/doi/abs/10.1002/jhm.2554
2. Teamwork and Leadership in Cardiopulmonary Resuscitation | Journal of the American College of Cardiology (jacc.org) https://www.jacc.org/doi/abs/10.1016/j.jacc.2011.03.017