The number of Australian-theme Outback Steakhouse restaurants has grown to 898 from zero in 17 years. In healthcare, another inspiration from Down Under -- hospital rapid response teams -- has shown even more explosive growth, to roughly 1,400 U.S. hospitals today from no more than 50 two years ago, according to the Institute for Healthcare Improvement in Boston.
Australians are credited with developing the rapid response team concept, which focuses on identifying hospitalized patients as their conditions just start to decline and providing immediate, aggressive treatment. The typical team consists of a critical-care nurse, a respiratory therapist, and other support staff and physicians as needed.
Nurses are asked to call the team if they have a "gut feeling" a patient is in trouble or when physiological measures, such as sharp changes in blood pressure or heart rate, indicate there may be trouble.
Two factors influenced the rise of rapid response teams in the U.S., experts said. First, the federal Agency for Healthcare Research and Quality began using "failure to rescue" deaths -- hospital patients who die of medical complications -- as a quality measure. And the IHI began promoting rapid response teams in its "100,000 Lives" campaign.
The nearly year-old campaign seeks to avert 100,000 preventable patient deaths by encouraging hospitals to adopt rapid response teams, evidence-based care for heart attacks and various interventions to prevent adverse drug events, ventilator-associated pneumonia, and central-line and surgical-site infections.
The impact of the campaign on the growth of rapid response teams has been "absolutely huge," said Terri Simmonds, a nurse who is an IHI faculty member and director.
So far, Centura Health in Denver has deployed rapid response teams at 10 hospitals and will expand to one more in December, said Terry O'Rourke, M.D., the system's chief medical officer.
"We were talking about (rapid response teams), but our decision to participate in the IHI campaign certainly added some emphasis," O'Rourke said. "Our projections show we have the potential to save 50 to 100 lives (systemwide) annually, and our experiences so far could support that kind of an outcome -- or even better."
O'Rourke said it's too early for definitive data, but rapid response teams have been getting 10 to 15 calls a month in Centura's larger hospitals and three to five a month in smaller facilities. The result, he said, has been fewer cardiac arrests.
At Baptist Memorial Hospital-Memphis (Tenn.), staff were so impressed with rapid response teams after an IHI educational program, they ran a three-day pilot test in August 2003 and the hospital has used rapid response teams ever since.
"In those three days, the team saw 10 patients from eight different units," said Jan Padgett, manager of the hospital's intensive-care unit. "The support we received from physicians led administrators to just say, 'Go ahead and start.' "
Melanie Polzin, the ICU's head nurse, said the team typically gets 120 calls a month. "There are no inappropriate calls," Polzin said. "If someone was concerned enough to call us, it was an appropriate call."
Padgett echoed the sentiment. "We're not like Superman there to save the day," she said. "We're there to help the nurse, have her understand what's going on, and to communicate with the doctor if necessary."
Before rapid response teams were implemented, the survival rate of "coding" patients at Baptist was around 14%. In the last month, it was about 20% and has been as high as 40%.
Centura and Baptist officials said nurses' morale appeared to be higher with the implementation of rapid response teams, and they hoped that would lead to higher retention. Although there was concern about potential turf battles between rapid response teams and attending physicians, that hasn't been a problem.
"We made it clear that the attending physician is still the person in charge," Centura's O'Rourke said. "There's no ambiguity at all."
Simmonds said concern over turf battles typically dissipates quickly. "Once organizations move forward, physicians embrace the concept because they know this team of experts is available to assist with the care for their patient 24 hours a day," she said.
