Author: Clinton Fildes
Fildes, Clinton, 2022 A time-conscious, safety-focused exploration of two different nursing models in the rapid response service, Flinders University, College of Nursing and Health Sciences
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Many acute hospitals do not have sufficient funding to maintain a dedicated Rapid Response Team nursing model. Therefore, Intensive Care Unit nurses are often used in a dual Intensive Care Unit/Rapid Response Team role, this type of model includes concurrent patient care allocation and attendance at rapid response calls as needed. Research has shown that the use of a dual model is associated with high workloads/overload, risks of burnout to nursing staff, and an increase in the number of negative adverse events in the Intensive Care Unit.
A literature review was undertaken to examine the consequences of intensive care nurse absence from the Intensive Care Unit and how Rapid Response Teams can impact Intensive Care Unit work. This led to a single-centre retrospective exploratory cohort study examining two different nursing models for the rapid response service and the associations between nurses’ time, adverse events, and rapid response call outcomes. This study examined the difference between a model using an intensive care nurse on patient care with rapid response duties, and a rapid response model with two dedicated rapid response nurses. Two key time points were examined in this retrospective study, each period is eight months, which allowed for data from two different nursing models.
The study data were subject to exploratory data analysis using IBM SPSS Statistics. Analysis of data demonstrated that the use of dedicated Rapid Response Team nurses was associated with a reduced reliance on dual Intensive Care Unit/Rapid Response Team nurses, reduced rapid response calls for in-hospital arrests and reduced rapid response calls resulting in patient death. However, increases were noted in the average scene time at rapid response calls and increased Rapid Response Team overall caseload (relative to Intensive Care Unit workload) with the use of the model with dedicated rapid response nurses. A remarkable finding was the increase in patient mortality in this sample when nurses with dual responsibilities were used; where the odds of patient death during rapid response calls were three times more likely than not, when compared with attendance by nurses dedicated to rapid response duties.
The results indicate that there were significant differences in patient outcomes between the nurses with dual Intensive Care Unit/Rapid Response Team duties and the nurses with dedicated rapid response duties. The dedicated nursing team model showed numerous benefits. On this basis, it is recommended that hospital organisations use a dedicated Rapid Response Team nursing model and limit the use of the dual Intensive Care Unit/Rapid Response Team nursing model. Further research is needed to confirm these observational, single-centre findings.
Keywords: Intensive care unit, ICU, rapid response team, RRT, workload, nursing, critical care
Subject: Nursing thesis
Thesis type: Masters
Completed: 2022
School: College of Nursing and Health Sciences
Supervisor: Professor Diane Chamberlain