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The Secrets of a Highly Successful RRT

The Secrets of a Highly Successful RRT. Kirsten Pyle RN, CCRN Sepsis Coordinator Mission Hospital Mission Viejo, California kirsten.pyle@stjoe.org. IHI ’s 5M Lives Campaign.

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The Secrets of a Highly Successful RRT

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  1. The Secrets of a Highly Successful RRT Kirsten Pyle RN, CCRN Sepsis Coordinator Mission Hospital Mission Viejo, California kirsten.pyle@stjoe.org

  2. IHI’s 5M Lives Campaign • Engage US hospitals in a commitment to implement changes in practice, proven to improve patient care and prevent avoidable deaths • RRT’s prevent deaths in patients who are failing outside intensive care settings • Assess • Stabilize • Assist with communication • Educate and support • Assist with transfer, if necessary www.ihi.org

  3. Variation in Care Practices • As of 2003, there were 1,739 U.S. hospitals in the IHI comparative database that exhibit a 450 percent variation in a patients chance for dying Institute for Healthcare Improvement white paper. Move Your Dot. Measuring, Evaluating, and Reducing Hospital Mortality Rates. 2003

  4. Sometimes implementing a good idea is an art…

  5. Research • Crit Care. 2008 Jan 23;12(1):205 • It appears likely that the accumulation of evidence from different settings and situations, though methodologically imperfect, will increase the rationale and logic of RRS. A conclusive randomized controlled trial is unlikely to occur. Tee A, Calzavacca P, Licari E, Goldsmith D, Bellomo R.Department of Intensive Care and Department of Surgery (Melbourne University), Austin Hospital, Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia. rinaldo.bellomo@austin.org.au.

  6. >25 articles with statistically significant improvements Mortality Number of codes outside of ICU Number of transfers into ICU Other recent conclusions: NNT Expert resource Effective treatment of shock Research McCauley K. Changing the work environment in ICU to achieve pt-focused care: The time has come. Am J. C., Nov 2006; 15:541-548.

  7. Secrets of Success • Funding • Team Model • Data use • Hiring the right person

  8. Gain Administrative Approval • Culture of “strengthening efficiencies” and identification of non-beneficial resources • How do we fund a 24/7 model? • With 4.2 FTE’s • Cost-Neutral Approach • Divided up between all in-patient nursing units • ED • Tele • Step-down • Medical • Surgical • Other (OR, PACU, CT, ICU, L&D, Angio, Same day, Rehab, etc…)

  9. Standardized Procedures

  10. RRT Charting • Assessment • Treatment • SBAR • Algorithms • Data collection

  11. Event Recognition Daily rounding Prioritize patients at risk locally Expand your “referral base” Make sure everyone is on the lookout for deteriorating patients Families can be the best ‘watch dog’ Code “H”

  12. Information TechnologyTrack and Trigger Systems

  13. Reminder Cards(practice, practice, practice)

  14. Rewards for Calling • External • Thank you notes • Pin’s • Internal • Learning that calling a RRT yields a positive response • Data feedback • Short term care leads to long term benefits • Why it’s worth our time/energy

  15. Staff Survey • Intermittent surveys: • Response time adequate? • Clinical skills present and helpful? • Patient/family communication facilitated? • Staff communication adequate? • Utilization of the nursing process? • Ability to facilitate patients need?

  16. Search For the Truth • JCAHO 2004- • Mandates understanding of statistical tools as “essential to an effective assessment process.” • Control charts • Process/outcomes over time • How and when to act upon signals • Special cause vs. random variation • Leading indicators…if you tackle those, you will change your outcomes

  17. UCL Avg LCL What to do with your data Get data Brainstorm Investigate Ask Involve staff Fishbone

  18. Mortality RateStatistically Different (special cause variation noted, p=<0.05)

  19. Statistically Different(special cause variation)

  20. Numbers Matter! How many RRT calls do you want? For each 17 MET calls, one less cardiac arrest occurs Jones, Bellamo, et a. Critical Care 2005:9 R808-815- Australian Studies suggest 23 to 25 calls for every 1,000 admissions to decrease mortality reliably IHI.org

  21. Statistically Different(special cause variation)

  22. Statistically Different(special cause variation)

  23. Comparison • Comparison: • Summarize data available from other organizations which enable us to assess our relative performance. Include time frames and source references • Literature searches • Similar hospitals • Competition within your local market • Professional organizations • International sources

  24. Efficacy

  25. Benchmark & Performance Goals • Benchmark: • Identified best-in-class organization • Performance Goal: • Document the current organizational goal or target for each measure • Strive to be specific measurable, realistic, and include a time frame

  26. Conclusions & Recommendations: • Conclusions: SO WHAT? • Are there statistical differences? • Recommendations: NOW WHAT? • Heed the opportunity to improve and stabilize • Identify clinical or process issues • Identify who needs to do what by when

  27. Sometimes the answer is right in front of your nose…

  28. Where is the Waste?

  29. The Perfect Man For the Job…

  30. Through the Looking-Glass Lewis Caroll, 1872 The chess framework is full of absurdities and impossibilities • White side makes nine consecutive moves • Alice (a white pawn) becomes a Queen, to be two separate moves • The White King to be checked without either side taking any notice of the fact • The White Queen flees from the Red Knight, when she should take it

  31. Why Care About Attitudes?6 Secret Traits

  32. Humility • Not false modesty, but don’t denying your strengths • Realize you need further education…every day of your life • #1 secret to overcoming stress • Stress comes from desire to control • Seek further knowledge • Two heads are better than one

  33. Discernment • The ability to know what’s going on • Decide for yourself based on evidence • You don’t believe everything you hear • Is this really the truth? • Continually reevaluate • Beware, be careful, consider

  34. Possibility • Have faith in your staff • See the creativity and innovative approaches • Show them you trust in their ability • What would you like to change if you could? • Have faith it can be done

  35. Hospitality • Skills are easy, dealing with people is the most difficult • A lost art • The pace and pressure desensitizes us • Small groups teach many lessons • Welcome those onto your RRT moment • You represent nurses everywhere

  36. Civility

  37. Civility • Treat all with respect, even if you disagree • Restoration of credibility, civility, and responsibility in teamwork

  38. Benevolence • Charity and grace • Let them bring out the best in you, not the worst • Use your resources and knowledge to benefit others • The word will get out

  39. In the end…. Patients and families will never forget you!

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