Decreased ‘Code Blues’ and Unplanned ICU Admissions Recorded Since Rapid Response Team Established at Al Wakra Hospital
Doha, 25 January, 2020: An initiative introduced at Hamad Medical Corporation’s (HMC) Al Wakra Hospital is helping to improve the care of inpatients and has reduced the number of ‘code blues’ and unplanned ICU admissions at that hospital.
The Rapid Response Team, a group of specially-trained critical care specialists available to rush to the bedside of any patient who appears to be developing complications, was established in late 2017 and today includes six critical care nurses, respiratory therapists, and intensivists. Each month the team responds to an average of 24 calls, ranging from low blood pressure and blood oxygen levels to rapid breathing.
“Most patients will show signs and symptoms of increasing instability for several hours before an adverse event. For example, a patient at risk for a cardiac arrest will often experience changes in breathing, heart rate, or mental status. With the right tools there is an opportunity to rescue these patients early in their decline before a crisis occurs,” explains Mr. Mohammed Al Jonidi, Acting Director of Nursing, Critical Care Division, Al Wakra Hospital.
“The Rapid Response Team was formed from the goal of enabling high-acuity patient care to be delivered anywhere that it is needed in the hospital. We are a designated group of specially trained nurses, allied healthcare professionals, and doctors who can be assembled quickly to deliver advanced care assessment and treatment in response to the perceived or potential clinical deterioration of a patient,” added Mr. Al Jonidi, who also manages the Rapid Response Team.
In 2015, HMC introduced the Qatar Early Warning System (QEWS) across its network of hospitals as part of an effort to help clinical staff recognize deteriorating patients before they became very sick. QEWS categorizes a patient's severity of illness by using a scoring system that prompts medical intervention at specific trigger points. Mr. Al Jonidi explains that after the successful implementation of QEWS at Al Wakra Hospital there was a desire to do more to improve the outcome of sudden patient deterioration in the hospital and the Rapid Response Team was established.
Dr. Edin Karic, Chief of the Critical Care Division, says the aim of the Rapid Response Team differs from that of teams who respond to a ‘code blue’ in that the goal is to intervene before the onset of injury, respiratory arrest, or cardiac arrest.
“The goal of a ‘code blue’ is to perform resuscitation efforts after a person has stopped breathing, or after a person’s heart has stopped beating. The goal of the Rapid Response Team is preventative. The Rapid Response Team intervenes in the early stage of a potential code situation, relying on bedside nurses to prompt their action. Bedside nurses are highly sensitive to signs that a patient’s condition is deteriorating,” said Dr. Karic.
“Due to the effectiveness of our Rapid Response Team, they are now called upon to respond to adult ‘code blues’ as well. In addition to decreasing the number of ‘code blues’ here at Al Wakra Hospital, the Rapid Response Team has helped empower bedside nurses by helping them to honor their instincts and gut feelings about when a patient might be heading toward clinical instability. The team has also provided comfort to the families of patients by responding to their worries and concerns promptly,” said Dr. Karic.
In addition to reduced ‘code blues’, since the specially trained team was formed, Al Wakra Hospital has also recorded a decreased number of unplanned ICU admissions, decreased reactivation of adverse conditions, and enhanced patient safety, which Dr. Karic credits to a timely multidisciplinary approach to care.