The Center for Adult Critical Care, Virginia Commonwealth University Medical Center, ... Objectives ... Daytime Intensivist is present for the rapid response call.
INTENSIVIST STAFFING OF A TERTIARY ACADEMIC RAPID RESPONSE SYSTEM PERCEPTIONS OF ADDED VALUE Sammy Pedram1,2, Markos G. Kashiouris1,2, Shannon F. Lubin3, Kristin B. Miller1,2, Orlando Debesa1,2, Ray W. Shepherd1,2, Thomas C. Iden1,2, Rajiv Malhotra1,2, Curtis N. Sessler1,2 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia 2. The Center for Adult Critical Care, Virginia Commonwealth University Medical Center, Richmond, Virginia 3. Rapid Response Team, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
Introduction Purpose • To investigate the frontline provider satisfaction and perceived effectiveness of adding a Daytime Intensivist to an existing rapid response system (RRS).
Median
In the event a close relative was hospitalized, I would have been more comforted to know that a Daytime Intensivist was available in the hospital. Based on your experience with the Daytime Intensivist program, how likely are you to recommend the implementation of a Daytime Intensivist program to RRT colleagues from other hospitals? The presence of the intensivist during code blue calls significantly enhanced the overall performance of the code, comparing to codes before the implementation of the program.
Methods
First Quartile
• Intensivists participated in rapid response team (RRT) calls, as well as code blue calls, and Coronary ICU Objectives consultations.
There is superior communication between RRT and physician teams (floor, ICU) when a Daytime Intensivist is present for the rapid response call.
Lower Adjacent Value
How important is for patient safety to have a Daytime Intensivist with the rapid response team (RRT)?
(First quartile – 1.5 IQR)
I am overall satisfied with the Daytime Intensivist program.
Figure 3: Daytime Intensivist responses
• Questions included a 5-point Likert scale (4 = strongly positive, 2 = neutral, 0 = strongly negative) or free text responses.
Figure 1: Bedside nurses’ responses Objectives Median Outlier In the event a close relative was hospitalized, I would have been more comforted to know that a Daytime Intensivist was available in the hospital.
Lower Adjacent Value
Median In the event a close relative was hospitalized, I would have been more comforted to know that a Daytime Intensivist was available in the hospital.
(25% Percentile) My patient is more likely to receive timely life-saving interventions, when a Daytime Intensivist is present during the RRT call.
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Bedside nurses felt that their patients received more timely lifesaving interventions (median 4, IQR [3-4]) and triage (median 4, IQR [3-4]) (Figure 1).
• The RRT nurses were satisfied with the Daytime Intensivists (median 4, IQR [3-4]), perceived superior communication with the primary physician teams (median 3, IQR [3-4]), superior code blue performance (median 4, IQR [2-4]), and importance for patient safety (median 4, IQR [4-4]) (Figure 2).
• In response to the hypothetical question, “in the event a close relative was hospitalized, I would have been more comforted to know that a Daytime Intensivist was available in the hospital”, participants indicated that they strongly agreed (Daytime Intensivists median 4, IQR [3-4], RRT nurses median 4, IQR [4-4] and bedside nurses median 4, IQR [3-4]).
The Daytime Intensivist facilitates with timely triage of patients to step-down/ ICU.
Outlier The Daytime Intensivist facilitates timely care for patients on the floor with worsening clinical status.
First Quartile (25% Percentile)
The decision to move my patient to a safer level of care (stepdown or ICU) is quicker, when a Daytime Intensivist is present during the RRT call.
• 100% (7/7) of Daytime Intensivists, 100% (7/7) of RRT nurses, and 73 ward nurses responded.
• Daytime Intensivists rated the experience as fulfilling (median score 3, IQR [3-4]) and perceived strengthened patient safety outside the ICU (median 4, IQR [4- 4]), timely care (median 4, IQR[4-4]) and triage (median 4, IQR [4-4]) (Figure 3).
• In March 2015 Daytime Intensivists, RRT nurses, and ward bedside nurses completed survey instruments (12, 10, and 4 questions, respectively) about the effectiveness of the program.
First Quartile
The RRT team has significantly more authority to deliver timely life-saving interventions, when a Daytime Intensivist is present during the RRT call.
(25% Percentile)
• The Daytime Intensivist program was implemented in October 2014.
(First quartile – 1.5 IQR)
Results
Figure 2: Rapid Response Nurses’ responses
Lower Adjacent Value (First quartile – 1.5 IQR)
• There were no negative ratings to any question by any survey respondent.
Conclusions
The Daytime Intensivist strengthens patient safety outside the ICU.
The overall Daytime Intensivist experience is fulfilling.
• Six months post implementation, ward nurses, RRT nurses, and Intensivists perceived the Daytime Intensivist program as feasible, effective, and highly beneficial to patient safety. • The addition of a dedicated Intensivist to an existing rapid response system was widely perceived as highly valuable to the care of clinically unstable ward patients.
Nothing to disclose
