Rapid Response Teams No Substitute for Wrong Bed Assignment
"During these times, everything goes wrong, ambulances are diverted, patients are boarded in emergency departments, patients are often prematurely discharged from the ICU to make room for more ill patients or elective surgical cases, nurses are overloaded and stressed and patient discharges take place prematurely, resulting in patient readmissions.
"On days like these, hospital clinicians and managers face an unlikable dilemma, to admit a patient to a nonpreferred unit or to board the patient in the emergency department or the postanesthesia care unit until a bed in the preferred unit becomes available.
"During these times," they continued, "proper placement is an exercise in wishful thinking and the definition of a preferred bed becomes 'the one that is available.'"
In an interview, Litvak said, "We put patients wherever there is a hole. We're not in the position to put the right patient in the right bed."
They added that the benefits of such teams, also called "Code Blue" teams, have not been proven. "RRT studies were often of poor quality and clinicians often failed to call an RRT when they should have, leading to uncertainty in the estimates of benefit."
"It seems perverse to measure the success of RRTs by counting the number of saved lives that were put at risk by triage errors, driven by ineffective management of patient flow," they wrote.
The concept of rapid response teams was developed decades ago in Australia, but it was greatly advanced in the U.S. by new Centers for Medicare & Medicaid Services director Don Berwick, MD, then president and CEO of the Institute for Healthcare Improvement. IHI made rapid response teams one of the seven safety strategies in its "100,000 Lives Campaign" in 2005.
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