The nation's largest healthcare philanthropy is throwing its weight behind hopes for the fast adoption of rapid-response teams, dispensing $1.8 million in grants to jump-start such programs at a minimum of 225 hospitals over the next 18 months.
The Princeton, N.J.-based Robert Wood Johnson Foundation awarded $225,000 to the not-for-profit Institute for Healthcare Improvement and $150,000 in grants to nine hospital organizations that will develop training programs and create learning networks for their member hospitals. Rapid-response teams are one of six interventions recommended by the IHI's 100K Lives campaign, which seeks to prevent 100,000 avoidable deaths by June 16, 2006.
In addition to saving lives, rapid-response teams are credited with helping hospitals increase nursing job satisfaction by taking away a layer of stress.
The use of rapid-response teams has grown quickly, but not fast enough for the Robert Wood Johnson Foundation. An estimated 1,400 hospitals nationwide have already implemented rapid-response teams from roughly 50 two years ago (Sept. 5, p. 33). Joe McCannon, director of the 100K Lives campaign, said 57% of the 3,000 hospitals that have joined the 100K Lives campaign are committed to implementing the teams, if not already deploying them.
"We believe every hospital should have a rapid-response team as a standard of care, and everyone should know if their local hospital has one or not," said Susan Hassmiller, senior program officer at the foundation.
Rapid-response teams aim to avert life-threatening medical catastrophes by aggressively deploying experienced clinicians to the bedside if a patient's condition becomes ambiguous enough to raise concerns. The teams provide assistance before a situation escalates into a critical event that could lead to serious complications, days in an intensive-care unit, or even death. Though the teams operate in a variety of ways at hospitals across the country, often they include an ICU nurse, a respiratory therapist and sometimes a hospitalist or intensivist, Hassmiller said.
The foundation considers the project one of its key strategies to address the nation's nursing shortage by providing a better work environment. The teams offer crucial support to overstretched nurses, especially new, inexperienced nurses who might be unsure to ask for help when patients are not showing definitive signs of immediate distress, Hassmiller said.
At Tenet Healthcare Corp., one of the nine grant recipients and the only investor-owned system among them, the teams have been a terrific morale boost for nurses, said Jennifer Daley, Tenet's senior vice president for clinical quality and chief medical officer. Daley said 80% of Tenet's 69 hospitals have rapid-response teams on one or more units, and 37 Tenet hospitals will be participating in the grant initiative.
No one has explicitly studied the cost savings associated with the teams, but one Australian study calculated a 75% reduction in the number of patients admitted to the ICU as a result of rapid-response teams, said Michael DeVita, an associate professor of critical-care medicine at the University of Pittsburgh Medical Center, in an e-mail. "The cost benefit was in the millions," he said.
DeVita has run a team of the same type since 1988 at UPMC Presbyterian. At UPMC Shadyside, a rapid-response team that is part of a collaborative effort between the IHI and the foundation--called Transforming Care at the Bedside--has saved 13 lives in one year, according to the foundation.
The IHI will earmark some of the grant money to study the cost implications of rapid-response teams, McCannon said. But it almost certainly saves costs. There are several examples of hospitals introducing teams that averted a significant number of "codes" outside the ICU without requiring any additional staffing, he said.
Another grant recipient, the North Carolina Hospital Foundation, the charity arm of the North Carolina Hospital Association, expects to implement teams in at least 50 hospitals, said Jeff Spade, vice president of the NCHA. There's great interest for rapid-response teams in North Carolina, where more than 100 of the state's 130 hospitals are already participating in the 100K Lives campaign, he said.
The association's foundation is partnering with a collaborative, including hospital alliances Premier and VHA, to offer collaborative learning networks to any hospital that wants to start a rapid-response team or sharpen an existing team.