Spotlight

The response team at Stanford Health Care consists of two teams – the Critical Care Response Team and the Acute Care Response Team. This article will present how the teams were built on evidence demonstrating the need to deliver optimal care in a focused manner in hospitals.

Stanford Health Care’s Response Team

Successful programs are built on a foundation of evidence taken from research in the literature. Stanford Health Care’s Response Team truly highlights this ideal as it was structured based on the best available literature and continues to evolve with emerging research program. This article will highlight the development and evolution of the Rapid Response team at Stanford Health Care and how it utilized groundbreaking research to create a world class service. The Critical Care Response Team intervenes with patients whose condition deteriorates unexpectedly by drawing clinical experts quickly to the patient’s bedside. The Acute Care Response Team primarily provides support to the Hematology and Oncology Departments and assists with the administration of chemotherapy, as well as provides education to patients and staff.

According to the publication by Winters and Devita (2017) Rapid Response Systems[i], the critical care response nurse (CCRN) concept was initially envisioned in the early 1990s as healthcare systems became more complex and a need for early trained intervention arose. The evolution of these teams started with groundbreaking research that identified early signs of deterioration prior to cardiopulmonary arrest.  Schein et al. (1990)[ii] found that “…cardiopulmonary arrest is neither a sudden nor unpredictable event.” This forever formalized what many health care providers had observed for years and established precedence for early intervention. This new knowledge triggered the formation of rapid response teams across the country as health care systems looked for new ways to reduce preventable deaths. Research after began to emerge focusing on the importance of having a multidisciplinary team of doctor, critical care nurses, pharmacists, and respiratory therapists intervene during those early signs and symptoms to prevent cardiopulmonary arrest. One of the pivotal publications by Bellomo et al. (2003)[iii] showed dramatic improvement in survival rates stating, “the incidence of in hospital cardiac arrest and death following cardiac arrest, bed occupancy related to cardiac arrest, and overall in hospital mortality decreased after introducing an intensive care based medical emergency team.” This early research led to the creation of Stanford Health Care’s Response Team in an effort to improve patient outcomes and reduce preventable deaths.

Stanford’s response program started off more as a ‘help-line’ with only one response nurse available during the evening and night shifts in the early 1990s.  This nurse was utilized to help start difficult IVs, provided wound care, and acted like a float nurse to 9 different units.  In 1994, the role evolved when the critical care response nurse began to carry a pager to answer to all the Code Blues, major traumas in the ED, and give breaks in the PACU and all the ICUs.  Another evolution to the role of the critical care response nurse occurred after research was published about the success of the Rapid Response Team to life threatening events.  In the early 2000s, rapid response calls were now being initiated followed by CAPR bed activations (i.e. Stroke Interventional Radiology Patients) and sepsis patients.  This shift in culture led to an ever-growing team, with their responsibilities continuing to expand utilizing a greater breath of nursing’s scope of practice. Currently, they are a team of 26 critical care or emergency trained nursing professionals and 14 oncology certified acute care nurses.  They are split into two teams, Critical Care Response Team and Acute Care Response Team.  Below is a list of some of the services the response team help facilitate here at Stanford Health Care.

Critical Care Team provides the following care:

  • Sepsis Care (all units)
    • Manage alerts that bring additional resources to the bedside
    • Experts at differentiating potential causes of deterioration
    • Ability to implement sepsis protocols and activate Code Sepsis
    • Evaluate and facilitate appropriate level of care for new onset or worsening sepsis
  • Critical Care (all ICU, ED, and step-down units)
    • First line emergency response during critical change in patient condition (i.e. Code Blue, Stroke Code, Rapid Response)
    • Emergency Department resource for major trauma and critical care areas
    • Deliver time sensitive critical care interventions for acute stroke patients
  • General Care (all ICU and step-down units)
    • Insertion of difficult to place or specialized lines and/or tubes (i.e. IVs, NGs, Foleys, Feeding Tubes)
    • Assisting all the Intensive Care Units (i.e. helping when needed)
    • Real time education where care meets the patient at the bedside
    • Able to participate in challenging conversations with patients and families

Acute Care Team provides the following care for all non-ICU/ step-down units

  • Oncology (applies to all NON-oncology units)
    • Manage alerts for patients admitted with an active oncology treatment plan
    • Administer chemotherapy agents to patients
    • Provide chemotherapy education to patients and their loved ones
    • Provide oncology and chemotherapy education to the nursing staff
    • Resource to nursing staff administering hazardous agents
    • Collaborative approach with heme/onc fellow and oncology pharmacist in the management of off-unit chemotherapy
  • General Care
    • Insertion of difficult to place lines or tubes (i.e. two failed PIV attempts)
    • Insertion and maintenance of feeding tubes with electromagnetic guidance (i.e. Cortrak)
    • Experts in management of PICC line removal and ports (Mediport)
    • Able to participate in challenging conversations with patients and families
    • Acts as a resource to floor staff and offer input for problem solving

This diversified nursing team was created for the hospital, supported by evidence from the literature, to answer to all emergency response activations or other unpredictable situations requiring additional nursing care.  The critical care response team and the acute care response team have grown substantially over the last 20 years with their continued mission: to support a collaborative and interdisciplinary approach that ensures quality patient care and clinical excellence across the hospital continuum.

Manager: Amanda Giordano 408-656-2872

Shared Leadership Council Members: Dana Shepard, Eli Oh, and Heather Jenkins

Voalte: SHC Critical Care RN 1-4 AND SHC Acute Care RN 1-2

 

References:

[i] Winters, B. and DeVita, M. (2017). Textbook of Rapid Response Systems.  Switzerland: Springer International Publishing

[ii] Schein, R. M., Hazday, N., Pena, M., Ruben, B. H., & Sprung, C. L. (1990). Clinical antecedents to in-hospital cardiopulmonary arrest. Chest, 98(6), 1388-1392.

[iii] Bellomo, R., Goldsmith, D., Uchino, S., Buckmaster, J., Hart, G. K., Opdam, H., … & Gutteridge, G. (2003). A prospective before‐and‐after trial of a medical emergency team. Medical Journal of Australia, 179(6), 283-287.

 

Article By: Dana Shepard & Heather Jenkins

Book an appointment or get a consultation.