Rapid response teams (RRTs), first described in the 1990s, have been commonplace in US hospitals since the late 2000s, when the Institute for Healthcare Improvement included RRT as a key intervention in the 100,000 Lives Campaign and the Joint Commission added improving “recognition and response to changes in a patient’s condition” as a National Patient Safety Goal. Subsequently, numerous articles and studies, aimed primarily at hospital administrators, have debated their impact and ideal structure, but little attention has been directed to the actual clinicians on the front lines of these teams.
It goes without saying that the nurses, providers, and/or respiratory therapists making up the RRT need impeccable clinical skills. After all, they are extending critical care resources and skills outside the intensive care unit (ICU) and, in that regard, are functioning as a clinical Swiss Army Knife, with the ability to expertly handle respiratory, cardiac, neurologic, and other clinical emergencies on the fly. What’s less well understood is that these teams require impeccable political skills as well.
Rapid response systems require activation from the front lines to function, and since RRTs are generally not the primary service, they are often dependent on others to be mobilized. Since the success of RRTs in improving patient outcomes is known to correlate with the number of RRT activations, the effectiveness of the team depends in large part on the willingness of the primary service to want RRT help. As such, RRT members are part craftsperson, delivering expert care, and part salesperson, encouraging the hospital to use their services. We have found that it is often missed opportunities in the latter aspect of the job that gets these teams in trouble and limits their impact, despite having dedicated and experienced clinicians staffing the teams. We therefore propose the following ten commandments for hospital rapid response teams to combat this political vulnerability:
- Thou Shalt Never Show Contempt: It is highly likely that you are more experienced and knowledgeable than the primary team about the critical condition you are being consulted to help manage. However, the slightest whiff of contempt (such as a snide comment muttered under your breath or even a subtle eye roll) is toxic to the collaboration you need to care for the patient in front of you and, most importantly, to the likelihood of your services being requested in the future.
- Thou Shalt Not Get Distracted by non-RRT Patients and Tasks: You are a clinical jack-of-all-trades who knows your way around the hospital. These skills lend themselves to being very helpful to a number of colleagues, but this can be a slippery slope. You cannot be both the hospital peripheral IV team and proactively evaluate high-risk patients. There is a fine line between being a team player and protecting your time for clinical deterioration, but it’s easier to stay focused on your charge if you are consistent in dedicating your efforts to RRT-activated cases and interventions for those patients who may be at risk.
- Thou Shalt Not Overstaff RRTs: The majority of RRT calls should not require advanced skills, such as intubation or central line placement, which might require additional specialized providers. So, while it’s tempting to come prepared for anything, when you consistently send more people to activations than needed, you exacerbate the risk of frustrated responders (who will undoubtedly express that frustration in front of the requesting team) and increase the activation barrier to future calls. Consider reducing the first line responder(s) to just the essential, possibly even limiting to one person, who can then call for backup, if needed.
- Thou Shalt Encourage Formal RRT Activation: One of the main reasons for underutilization of RRT is that calling colleagues for help is inherently vulnerable. Clinicians often mitigate that discomfort by avoiding it entirely or by circumventing the standard activation protocol with a personal text or “heads up” about a worrisome patient as you dash by. While it’s tempting to encourage personal contact methods to lower the activation threshold, promoting official RRT activation ensures consistent prioritization, documentation, and response.
- Thou Shalt Show Gratitude for Every Call: Remember that whoever activates the RRT has likely overcome significant internal resistance to asking for help and possibly even explicit pushback from other clinicians. So even if you don’t think your skills are needed, make the point of validating the decision to call and expressing gratitude to whomever made the call. It will go a long way to encouraging future calls when your participation may be more critical to the patient outcome.
- Thou Shalt Not Undermine the Primary Service: While you may be more knowledgeable about the clinical process and management of acute deterioration, the primary team knows the patient better and has built a trusting relationship with them over time. Damaging that sense of trust undermines the patient and their family’s overall sense of safety in their care. If you disagree with the primary service, express it quietly and tactfully outside the room, and ultimately remember that it’s the primary team’s call; you’re a consultant.
- Thou Shalt Call for Backup When Needed: RRT members are not immune from the vulnerability associated with needing help. Recognize your potential savior complex and limitations, and practice what you preach – asking for help is not a sign of weakness.
- Thou Shalt Round Proactively: Despite your best efforts to encourage RRT activation, it is likely that there will still be deteriorating patients that are missed by the frontline teams. Use your time between formal RRT activations to proactively assess patients at increased risk of deterioration. In addition to the opportunity for earlier intervention, making the rounds on the nursing units gives you the chance to connect with nursing staff and providers outside of an RRT response. In doing so, you can build trust so that you’re not just a nameless emergency contact and also remind them to formally activate RRT, when needed.
- Thou Shalt Regularly Share Success: Don’t wait until you’re asked formally to show your value because at that point, it may be too late. Proactively publicize saves, as these reinforce the value of the RRT to all stakeholders and encourages its utilization. Remember that these are shared wins: for those who activate the RRT, the responders, the patient, and the health system as a whole. Even as you collect hard, statistical data, don’t underestimate the power of anecdotes.
- Thou Shalt Measure Return on Investment (ROI): Clinical priorities are more fickle than financial ones, with hospitals under constant pressure to reduce costs. Be prepared to demonstrate your team’s impact and value, preferably in financial metrics such as reduced length of stay, ICU bed days, and mortality to guard against being on the chopping block in the next round of budget cuts. Paired with specific save stories, these metrics can meaningfully demonstrate program success.
Let us know if we missed any. We’d love to hear from you.
About AgileMD
At AgileMD, we are driven to improve patient outcomes by making evidence-based care universally accessible. This blog is dedicated to topics that keep us up at night, on which we have deep interest or expertise. Our clinical decision support software products have been used by over 135,000 providers in over 250 U.S. hospitals in the care of more than 4 million patient encounters. Since our founding at the University of Chicago, our work has been evaluated in 80 peer-reviewed publications, and we have received nearly $3 million in federal funding from the U.S. Department Health & Human Services (HHS).
eCART™ guides care teams to the highest-risk hospitalized patients using industry-leading, FDA-cleared AI combined with actionable, embedded decision support for all-cause clinical deterioration. Clinical Pathways give care teams immediate access to the most updated protocols, streamlining order entry and documentation directly in their EHR workflows.
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