Vladimir Kvetan, MD
Chief, Division of Critical Care Medicine
Failure to plan, communicate, and recognize a deteriorating patient condition are fundamental problems that can lead to failure to rescue and unnecessary readmission to the intensive care unit (ICU). Establishing rapid response teams--clinicians who bring critical care expertise to the bedside--has been shown to significantly lower risk reduction and inpatient deaths.
The Critical Care Medicine (CCM) Rapid Response Team, part of Montefiore Medical Center’s commitment to quality improvement and best practices, has been in place since 1983 as the Critical Care Medicine consult service but was recently established as a section with the physiologic goals of preventing death in patients throughout the hospital by empowering nurses to trust their intuition and call on an extra set of experienced eyes to assess patients in potential decline. The Rapid Response Team, part of the Division of Critical Care Medicine's 24/7 "ICU Without Walls", is composed of the CCM fellow on call, a respiratory therapist, and trained critical care nurses supported by the critical care attending physician on 24/7 in-house call. The Rapid Response team strives to help clinical staff members recognize medical crisis situations early; activate early intervention to such crises; support primary teams and families; and improve patient safety, satisfaction, and outcomes.
Any Montefiore Medical Center clinical staff member may call on the team if they notice a change in a patient’s vital signs or alertness, respiratory problems, chest pains, or more subtle fluctuation that may signal an adverse event. Examples of cases in which the Rapid Response Team would be alerted include the following:
- Respiratory distress or threatened airway
- Respiratory rate <8 or >36 breaths/minute
- New severe hypoxemia by pulse oximetery <90% while on oxygen
- New Systolic blood pressure < 90 Mm hg with symptoms
- Pulse or Heart Rate <40 OR >140 beats/minute
- Sudden collapse or fall in level of consciousness
- Glasgow coma scale fall >2 points
- Repeated or prolonged seizures