Rapid Response Teams: Best Option for Emergency Care?

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"The way we schedule our elective admissions is less predictable that when patients break their legs and come into the emergency department," Litvak said.

The way elective admissions are scheduled in most hospitals, he said, is a holdover from several years ago, when hospitals could afford to have enough staff to cover any peak load. Scheduling of admission was essentially left up to individual doctors, who consulted their own needs -- perhaps attending a conference or some other outside activity -- rather than those of the institution.

It was "absolutely un-coordinated," he said.

Today, when staffing levels are much lower, that system by and large hasn't changed, Litvak said, but now it causes problems.

Should Hospitals Explore Other Emergency Care Solutions?

Where it has changed -- using Litvak and his colleagues' ideas about patient flow -- the difference has been dramatic, he said.

At Cincinnati Children's Hospital, administrators took over scheduling elective surgery, reserving some operating rooms at all times for emergencies. Combined with other changes, that smoothed out patient flow.

The result, Litvak said, was that the average bed occupancy rate went from about 76 percent to about 90 percent, avoiding the need for a planned 100-bed expansion. Periodic overcrowding became much less common. And the streamlining meant the hospital increased its revenue by about $137 million a year.

Litvak argues that if such changes took place across all U.S. hospitals, the saving would be about $1 trillion over 10 years.

Rather than focus on the best way to organize and operate rapid response teams, Litvak and Pronovost argue in the journal, researchers should be looking at ways to improve patient flow "to provide each patient with the right care at the right time, not more and not less."

Goldmann, however, said such institutional reflection is already occurring, and there still exists a place for RRTs.

"We actively look at the patients who require a rapid response or a code and we try and determine if it was something that should have been predicted -- was there something we should have done differently," he said.

"I would be surprised if there aren't hospitals that are so overwhelmed by the volume in emergency rooms and the number of patients requiring intensive care that placing patients in a timely way in ICU is a challenge. I would hope that those hospitals are examining ways to unload their systems. It's like many other areas of quality improvement where there are gaps and some institutions are further ahead than others, some are more challenged than others."

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