UNC Hospitals Establishes Rapid Response Team

Many hospitals have emergency resuscitation teams that spring into action when a patient goes into cardiopulmonary arrest — when the person’s heart or lungs, or both, stop working. When this happens at UNC Hospitals, it’s called a “Code Blue.”

Recent research shows that more lives could be saved if such teams were called into action at the first sign a patient’s condition is deteriorating, which could be several hours earlier than a Code Blue typically would be called. Based on this research, a growing number of U.S. hospitals have established what are being called “rapid response teams” for adult patients.

Developing a rapid response team is one of the six recommended interventions in the Institute for Healthcare Improvement’s (IHI) 100,000 Lives Campaign, and the UNC Hospitals have been a part of the campaign since it started last year. An Adult Rapid Response Team has also been developed in the UNC Hospitals.

A smaller number of medical centers, believed to be less than 20 nationwide, have created rapid response teams for their pediatric patients. On Aug. 1, 2005, the N.C. Children’s Hospital at UNC Hospitals became the first in North Carolina to activate its Pediatric Rapid Response Team.

“These teams are often very difficult to implement since they require a change in the culture of the hospital.”

“These teams are often very difficult to implement since they require a change in the culture of the hospital,” said Dr. Tina Schade Willis, a pediatric intensivist at the N.C. Children’s Hospital. Willis led the development of the Pediatric Rapid Response Team with Dr. Celeste Mayer, patient safety officer for UNC Hospitals.

“But here everyone from the leadership of UNC Hospitals and the N.C. Children’s Hospital to the bedside staff and resident physicians have contributed to the overwhelming acceptance of this life-saving, system-wide intervention.”

To date, the Pediatric Rapid Response Team at the N.C. Children’s Hospital is the only such team operating in the Triangle region. Statewide, only one other pediatric rapid response team is currently up and running.

At the N.C. Children’s Hospital, the Pediatric Response Team includes a pediatric critical care physician who serves as team leader, a pediatric critical care nurse and respiratory therapist, a pediatric resident physician as well as the doctors and nurses assigned to the patient.

Any member of the team, or any member of the hospital’s staff, can call it into action. And they are encouraged to do so, without worrying about the possibility of a false alarm. Staff are also instructed to call on behalf of family members. Even if the medical staff does not feel the patient fits criteria for the team to be called, if family members are worried about their child’s condition, the staff is instructed to call the team.

There are some key differences between the guidelines for triggering the Code Blue and Pediatric Rapid Response teams into action. In general, a Code Blue is called only after a patient is in cardiopulmonary arrest. In contrast, the N.C. Children’s Hospital staff has been encouraged to call the Pediatric Rapid Response Team for any of the following reasons:

* Staff or a family member is worried about the patient
(A “gut feeling” is more than enough)
* Acute changes in the patient’s heart rate, blood pressure, respiratory rate or oxygen saturation
* Mental status changes
* A new or prolonged seizure
* The patient has difficult to control pain or agitation

The results at the N.C. Children’s Hospital so far have been very encouraging. Since Aug. 1, the Pediatric Rapid Response Team has been called into action at least 19 times and there have been no Pediatric Code Blue activations for respiratory or cardiac arrest.

“In this new process, there are no false alarms and no negative feedback is to be given to the caller.”

“In this new process, there are no false alarms and no negative feedback is to be given to the caller,” Willis said. “The safety of the patient is what’s most important. We are partnering to create a culture where it is easier for medical staff to call for help.”

Media contact: Stephanie Crayton, (919) 966-2860 or scrayton@unch.unc.edu

The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. UNC Health Care is comprised of UNC Hospitals, ranked consistently among the best medical centers in the country; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; and Rex Healthcare and its provider network in Wake County.