• Mary Kay Bader, Beverly Neal, Linda Johnson, Kirsten Pyle, Jan Brewer, Michele Luna, Connie Stalcup, Margie Whittaker, and Michael Ritter.
• Mission Hospital, Mission Viego, California, USA. Badermk@aol.com
• Jt Comm J Qual Patient Saf. 2009 Apr 1;35(4):199-205.

BackgroundFrom 2003-2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mission Viejo, California) uncovered deficits in knowledge and judgment in the hours preceding 75% of our non-ICU patients. Nearly half of all arrests were occurring outside the ICU, with an overall mortality rate of 60%. In addition, transfers into ICU from the floor averaged 96 patients per month.MethodsA multidisciplinary team met for 12 months to develop a specialized nurse-driven rapid response team (RRT) to reduce the incidence and mortality of non-ICU arrests, reduce transfers to the ICU from the floor, and provide ICU-level nursing care for emergency department (ED) patients in extremis. The team developed an RRT protocol, a methodology for rounds and calls, and a data collection system. After gaining consensus among the nursing managers, 4.2 full-time equivalent (FTE) RRT nurse positions were created by each unit contributing portions of an FTE.ResultsProspective data collected demonstrated an inpatient call frequency averaging 118 calls per 1,000 discharges; 138 calls per month were in support of the ED. Floor codes were reduced from 36 to 17 per year, and the mortality rate in the floor-code patients decreased from 61% to 26%. Unanticipated transfers from the floor units to the ICU decreased significantly.DiscussionThe RRT initiative delivered measurable outcomes demonstrating the hospital's commitment to saving the vulnerable hospitalized patient population. In addition, the identification of critical system and clinical issues resulted in efforts to improve processes and identify patient subpopulations at risk (for example, patients with congestive heart failure, end-stage heart disease, high-dose narcotics).

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