The Value of Proactive Rounding by a Respiratory Therapist/Registered Nurse Rapid Response Team Model on the Professional Growth and Development of Bedside Registered Nurses

Abstract

Background:

Transdisciplinary rapid response models rests on the observation that adverse events in acutely ill patients are frequently preceded by an observable period of derangement in physiological parameters. Clinical deterioration occurs in 66—84% of patients up to 6 h prior to in-hospital cardiac arrest. Furthermore, 60% of patients transferred urgently to intensive care units (ICU) with potentially life-threatening conditions were documented as showing worsening in vital signs during the 8 h before their admission. RN and provider services directly involved in patient care reported that rapid response teams function well in managing patients who might be at risk for crisis, which is a critical aspect of an effective rapid response team. Many of the characteristics noted in rapid response teams are represented in our model. However our model consist of an RCP and a RN. Unlike other rapid response models, we include a proactive rounding element to assist in timely assessment of patients who are identified by the nursing and respiratory care staff as potentially unstable. Proactive rounding is also extended to patients outside of intensive care receiving noninvasive positive pressure and/or CPAP; patients receiving high flow nasal oxygen; and patients with surgical airways. Finally in our model we have included 'just-in-time' coaching for our bedside nurses caring for these patients in an effort to support their professional growth and development.

Methods:

We surveyed nurses in the adult medical/surgical acute care and transitional care areas of our 600 bed academic medical center. The goal was to ascertain whether (or not) RNs found 'just-in-time' coaching during rapid response team encounters effective in their growth and development as bedside practitioners.

Results:

The response rate to this survey was strong.86% of nurses surveyed either agreed or strongly agreed that rapid response team visits were effective in their growth and development during proactive rounding as well as rapid response calls. Of those nurses completing the survey 2.8% did not find rapid response team collaborations during a call to have any impact on their growth and development as practicing nurses.

Conclusions:

These survey results are positive. And suggest that proactive patient rounding by a rapid response team on patients identified as high risk for an adverse cardiopulmonary event significantly impact growth, development and practice in our registered nurses.