IHS Best of the Best Series: MET, RRT

From: IHI Mentor Hospitals for 100K Campaign

The Nebraska Medical Center – Omaha, NE

Availability Status: Available to answer requests
Licensed Beds: 548
Teaching / Non-Teaching Status: Teaching
Urban / Rural Status: Urban
Start Date of Intervention Work: August 2004
Mentor Contact Name: Terrie Johansen
Mentor Contact Email: tjohansen@nebraskamed.com
Mentor Contact Phone: 402-559-3432

Additional Information:
Initially implemented a Medical Emergency Team (MET) in August 2004. Observed low utilization
and lack of knowledge about program benefits as it relates to patient safety. In early summer of
2005 participated in UHC Commit to ACTion for RRT and as a result, changed policies and
procedures for the RRT, changed name of MET to RRT and created mandatory education program
for nursing about the RRT. RRT utilization has incrementally increased since August 2005 and
remains consistent. Nursing staff express increased satisfaction with the availability of this
resource. The organization is now preparing to implement a Pediatric RRT in February 2006.

RRT usage before August 2005: averaged at 2 calls per month.

RRT usage after August 2005: averaging at 14 calls per month.
Codes per 1000 discharges remain variable, ranging from 7.0 to 16.4 but with an average of 9.3
codes per 1000 discharges.

St. Catherine of Siena Medical Center – Smithtown, NY

Availability Status: Available to answer requests
Licensed Beds: 311
Teaching / Non-Teaching Status: Non-Teaching
Urban / Rural Status: Urban
Start Date of Intervention Work: December 2005
Mentor Contact Name: Gara Edelstein, Sr. VP, Patient Care Services, Chief Nursing Officer
Mentor Contact Email: gara.edelstein@chsli.org
Mentor Contact Phone: 631-862-3155

Additional Information:
We have created a Rapid Response team consisting of an ICU or CCU nurse, Respiratory Therapist,
Hospitalist or Nurse Practitioner and Nursing Supervisor. The team may be called any time a nurse
requires immediate attention for his/her patient. The patient is assessed and because there is a
hospitalist or NP on the team, immediate treatment begun. The patient may remain in their room
or moved to the critical care unit following the team call. There has been an overwhelmingly
positive response in our non-teaching hospital from the attending physicians, experienced nursing
staff as well as the new graduate nurses and has proven to be a significant retention strategy for
our nursing staff.

We have had 32 RRT calls throughout the facility in the first quarter of 2006 with the following
outcomes:

1) 63% reduction in cardiopulmonary emergencies (CE) outside the critical care units
2) 48% reduction in emergency intubations outside the critical care units
3) 88% of patients discharged home or to skilled nursing facility
4) Tremendous increase in nursing and physician satisfaction related to the ability to expedite care
to their patients by calling an RRT.
5) Improved communication to attending physician regarding patient's status