Some hospitals are allowing families to demand a rapid response team to assess their loved one’s condition.
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| Patrice L. Spath |
The family of a 45-year-old patient hospitalized with a stroke is anxious about his respiratory status. The family mentions their concerns to his physicians, nurses and therapists. No one seems to take their fears seriously. At many hospitals, this family might not know where to turn for help.
But not at Laurel Regional Hospital in Laurel, Md. Laurel Regional, as well as a few other hospitals throughout the country, encourage patients and family members to activate a rapid response team when they do not feel their concerns are being adequately addressed. At these hospitals, this family could request that a team of caregivers be summoned to assess their loved one’s condition and take appropriate action.
“Since implementing rapid response teams in early 2006,” says Maria Bellchambers, R.N., director of critical care and emergency services at Laurel Regional, “we’ve had two instances in which family members requested the team be activated. In both situations it was an appropriate use of the team, and the families’ concerns were promptly addressed.”
Call for HELP
Many hospitals implemented rapid response teams as part of their involvement in the 100,000 Lives Campaign of the Institute for Healthcare Improvement. (See www.ihi.org for more information.) However, very few have reached out to patients and family members to include them as part of the initiative.
UPMC Shadyside Hospital, a 486-bed affiliate of the University of Pittsburgh Medical Center, was one of the first organizations to implement a response team that could be initiated by patients and families. In late 2004, Tami Merryman, then vice president of patient care services at UPMC Shadyside, met Sorrel King and was inspired by her tragic story of a medical mishap involving her daughter Josie. (See www.josieking.org for more information.) Committed to doing what she could to prevent something like this from ever happening in Pittsburgh, Merryman kicked off an initiative called Condition Help (shortened to Condition H), in which family members can call a number on the hospital phone to employ a rapid response team.
At OSF St. Joseph Medical Center in Bloomington, Ill., the rapid response initiative is known as Call FIRST (Family Initiated Rapid Screening Team). By dialing 5000 from any hospital telephone, patients or family members can call for immediate help when they feel it is needed. The team is dispatched to the patient’s location within 10 minutes.
“We already had several ways for patients and families to ask routine questions or express concerns--manager rounding, executive team rounding, pastoral care visits, satisfaction surveys, etc.,” says Kathy Haig, director of quality resource management as well as patient safety officer and risk manager at OSF St. Joseph. “The Call FIRST initiative expanded our communication opportunities. It has been a good way to more directly involve the patient and family in their care.”
After implementing clinician-initiated STAT (stabilization, teaching, administration and transport) rapid response teams, NorthEast Medical Center (NEMC) in Concord, N.C., extended the process to allow patients or family members to activate the teams. This initiative is called Code Care.
Implementation
Condition H at UPMC Shadyside was launched housewide in July 2005 after a brief pilot period on one nursing unit following a mock Condition H with a real patient. “The challenges weren’t as great as most would expect,” says Beth Kuzminsky, R.N., M.S.N., staff associate for the Center for Quality Improvement and Innovation at UPMC. “Some staff initially feared that Condition H might be misused by patients or their families and the number of calls would be overwhelming. After implementation, these fears were quickly dispelled.”
In the first 13 months following the start of the initiative, Condition H has been called 38 times, with an average of 2.9 calls per month. “More than half of these calls potentially prevented a more serious clinical problem,” says Kuzminsky. “Equally impressive is patient response to Condition H. They see it as a true commitment by UPMC to do whatever it takes to keep them safe.” To ensure that callers’ needs are being met, someone from the responding team gets together with the patient and family within 24 hours of the event to determine if their concerns were satisfactorily resolved.
Call FIRST at OSF St. Joseph Medical Center began in March 2006, and in the first seven months the family-initiated rapid screening team was activated only twice. “We expected low usage,” says Haig. “If the number of calls had been high, then we’d have known there was a problem with our other patient/family communication mechanisms.”
The Actors
The Condition H team at UPMC includes a representative from the patient relations department, the administrative nursing coordinator on duty, one physician and staff from the patient’s location. This team includes somewhat different members than the teams dispatched for clinician-activated requests. “We speculated that Condition H calls might commonly be linked to communication breakdowns and psychosocial issues,” says Kuzminsky.
NEMC found that to be true. “In the beginning, the response team members were the same, regardless of who called for the team,” says Kim Barnhardt, R.N., C.C.R.N., clinical director of critical care at NEMC. “However, we soon discovered that most of the patient/family calls were related to inadequate communication or pain management concerns, not true medical emergencies.” Now, at NEMC only the nursing supervisor or nursing resources representative and the patient’s nurse responds to Code Care alerts. If the situation requires immediate medical attention, the full STAT team is activated.
At OSF St. Joseph, the rapid response team consists of a critical care nurse and respiratory therapist--the same team that responds to clinician-activated requests.
Educational Support
Patient and family education is an important component of a patient-initiated response team initiative. Brochures and other educational materials, supplemented by conversations with patients and family members, can help minimize abuse of the rapid response system.
“We needed to differentiate between our ASK FIRST system--a complaint hot line--and the Code Care system--our patient-initiated response team,” says NEMC’s Barnhardt. To accomplish this, NEMC created a variety of educational materials, including tent cards placed at the patient’s bedside and a one-page informational brochure. (See figure below.)
“In addition, we created a script for our nurses to say when they give the Code Care brochure to patients and family,” says Barnhardt. “The script reads, ‘Code Care is a help line that you can call if you feel like you or your loved one needs additional care during an emergency situation. Dial 8888 on any phone in the hospital. Within minutes, a small team of caregivers will arrive to help. This is a brochure that tells you more about Code Care.’”
Admitting nurses at UPMC Shadyside explain the Condition H program to patients and families. In patient rooms there are wall signs that explain Condition H and include the phone number to call. There are also stickers on patient telephones with the Condition H phone number. Posted on the hospital’s television bedside system is a patient safety video that includes remarks about Condition H, as well as the other safety initiatives at UPMC.
(In response to an overwhelming number of requests for more information about its Condition H program, UPMC has created an electronic toolkit. For more information about this toolkit, contact the Center for Quality Improvement and Innovation at UPMC at (412) 802-6950.)
Patients at Laurel Regional are not given a special hot line number to call. They are made aware of the hospital’s clinician-activated rapid response team through an informational brochure and a poster in each patient care area. These educational materials encourage patients or family members with concerns to ask the nurse or another staff member to activate the rapid response team.
“This process has worked well,” says Laurel Regional’s Maria Bellchambers. “Our medical staff and administration are committed to involving patients and families in the health care experience. This is just one more important way of showing that commitment.”
While the process of patient-activated rapid response teams differs somewhat among hospitals, one principle is consistent. Hospital and medical staff leaders recognize that empowering patients and families to get immediate attention when they have concerns is the right thing to do.
Patrice L. Spath, B.A., RHIT, is a health care quality specialist and principal of Brown-Spath & Associates in Forest Grove, Ore. She is also the author and editor of Partnering with Patients to Reduce Medical Errors (AHA Press, 2004).
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Figure: Text of NorthEast Medical Center Informational Brochure
Code Care, Rapid Response Team
NEMC is dedicated to making the hospital a safe place for patient care to happen.
As a response to providing the best care to our patients, we created a Code Care response.
Code Care was created to address the needs of the patient in the case of an emergency or when the patient is unable to get the attention of a health care provider. This call will provide our patients and families an avenue to call for immediate help when they feel they are not receiving adequate medical attention in an emergent situation.
When to call
- If a noticeable medical change in the patient occurs that needs immediate attention and the health care team is not recognizing the concern.
- If there is a breakdown in how care is being given and/or confusion over what needs to be done for the patient in an emergent situation.
To access Code Care, please call 8888 from a hospital phone. The operator will ask for caller identification, room number, patient name and patient concern. The operator will immediately activate a “Code Care” where a team of medical professionals are alerted and will arrive in the room to assess the situation. Additional clinical supports will be called in as needed.
In offering our families the Code Care option, we want you to know that you are our partners in care. If you have any questions, please discuss them with one of our health care providers.
This article 1st appeared on February 20, 2007 in HHN Magazine online site.
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