In the January 2019 International Journal of Nursing Studies article, “Can proactive rapid response team rounding improve surveillance and reduce unplanned escalations in care? A controlled before and after study,” Valerie Danesh, PhD, RN, FCCM, from The University of Texas at Austin School of Nursing, and a research team from several universities describe results from their study comparing reactive (or standard) rapid response to proactive rapid response.
The purpose of the controlled, before and after study was, “to examine the effect of an Early Warning Score-guided proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care.” The setting was a 237-bed community non-teaching hospital in Florida.
“In traditional rapid response teams, the consultation and management of clinical deterioration by the rapid response team is set up as a reactive process,” the authors explain. In contrast, “Proactive rapid response team rounding does not require a manual referral or invitation to intervene with patients at increased risk for clinical deterioration. Instead, rapid response team members make routine rounds on patients throughout the hospital following their review of automated risk profiles.”
For the proactive arm of the study, the hospital used The Rothman Index, the most scientifically validated patient acuity measure. The Rothman Index derives one simple score from data in the electronic medical record to create a picture of any patient’s condition over time – any age, any disease, any unit. The Rothman Index is proven to reduce mortality in practice. The research team chose to measure unplanned escalations in care, particularly unplanned ICU transfers, as a type of Failure to Rescue, because those transfers “place patients at a greater risk for hospital mortality, greater severity of illness, and longer hospital stays.”
- Unplanned ICU transfers were 1.4 times more likely to occur during the rapid response team baseline period compared with the Rothman Index-guided proactive rapid response team intervention period.
- “This study provides empirical evidence to support a new direction for the evolution of rapid response systems.” Proactive care guided by an automated measure of patient acuity allows for earlier intervention and the prevention of deterioration.
- “When coaching patient care, Intervention Model nurses offered guidance and advice for care planning and facilitated dialogue with family members at the bedside, including code status, contact isolation procedures, intubation decision-making and end-of-life/palliation discussions.”
The authors conclude, “Implementation of this model has implications for patient outcomes, hospital operations and costs.”
To learn more about the power of the Rothman Index, view PeraHealth’s on-demand webinar: “Would Your EMR Have Saved This Patient’s Life? Discover the Rothman Index with an Early-Intervention Patient Case Study.”