Cardiac arrest can occur quickly and may be difficult to detect, even in a hospital setting. It takes specially trained medical staff to recognize changes in patients that cannot be seen on a chart. Laura Kierol Andrews, PhD, APRN, ACNP, Assistant Professor of Adult Advanced Practice Nursing at Yale University School of Nursing and a Senior Acute Care Nurse Practitioner at the Hospital of Central Connecticut in New Britain, was asked to start a Medical Rapid Response Team (MRRT) that seeks to reduce the number of cardiac arrests in the hospital.

Before this program was implemented, it was difficult to ensure correct treatment for all patients at risk for cardiac arrest. Now, with the combined knowledge of the floor staff and Andrews's team, therapy is provided earlier for patients in need. "Our goal was to reduce the number of cardiac arrests in the hospital by 50 percent," Andrews stated. "According to the statistics we have now, cardiac arrests in the hospital have decreased by 62 percent."

The rapid response team concept was formed in response to national data showing that 70 percent of cardiac arrest patients showed signs in the eight hours prior to their episode that were not recognized by or communicated to medical staff. The program was set up to address this so-called "failure to rescue" phenomenon.

"Two and a half years ago, I was asked to establish and manage this program, as well as formulate the team, set up logistics, and make sure everything runs smoothly. I have my PhD and am an experienced acute care nurse practitioner, and being a nursing professor helps me to be a better clinician," Andrews added.

Each MRRT is composed of three different health care professionals: a critical care nurse, a respiratory therapist, and an acute care practitioner. Each member of the team has different health care experience, and each person's expertise is valuable in order to recognize which patients require immediate assistance.

Unlike the floor staff, the MRRT is called in whenever necessary, instead of following a normal routine; this means members are on call 24/7. Normally, the team works with the critical care unit, but their responsibilities vary from day to day. Team members are called in by nurses or doctors on the floor if they have patients suffering from chest pain, shortness of breath, or worsening respiratory function. There are always three different responders (critical care nurse, respiratory therapist, acute care practitioner) on hand in the hospital at any given time. Andrews believes that the variety within the team makes it more effective.

With every scenario the team encounters, each member contributes by utilizing his or her individual skill sets. First, the critical care nurse provides an assessment and draws blood if needed, while the team leader looks over the patient's charts. Critical care nurses also administer therapy or medication and transport the patient to the Emergency Room or Intensive Care Unit. "Those with critical care experience really make a difference because of their education and background. They are able to recognize patients instantly that are deteriorating by their behavior. Critical care nurses serve as role models for the floor staff, because they can quickly assess a patient's status," Andrews said.

Next, the respiratory therapist provides oxygen therapy, draws arterial blood gases, assists the anesthesiologist, and checks to see if the patient needs to be intubated.

The acute care practitioner is the final member of the team and serves as the team leader. Acute care practitioners communicate between the team and nursing staff on the floor in order to decide which course of action is best for the patient. They have prescriptive authority, meaning that they decide which medications and tests to give the patient, such as a chest x-ray or electrocardiogram. Lastly, they interpret the completed tests, prescribe emergency medications, and decide where the patient needs to be transported.

There are many different causes for cardiac arrest, but the team commonly sees patients before they go into septic shock. When patients begin to "go septic" from inflammation of an infection, they are one step away from experiencing septic shock, which leads to multiple organ failure, including cardiac arrest. Patients need to be diagnosed quickly while they are still septic so they can receive proper care.

"The team often identifies septic patients by their behavior," Andrews continued. "Before going into septic shock, patients can become feverish, confused, and have an increased respiratory rate."

However, these signs aren't always present; the floor nurses and doctors have been educated to recognize subtle differences in patients that may be overlooked. "The floor staff will say they look different than they did yesterday. One of the nurses from the team will say, 'I'm not sure what's wrong, but he or she is different,'" Andrews added.

The program created a mechanism for doctors and nurses to then activate the MRRT. Increased communication like this between the staff has made identifying these patients a simpler task. "These nurses know how to quickly assess patients on the floor and will transport them to either the ICU or ER if necessary. Patients that get that sick need a lot of nursing care, and if the floor nurses have five or six patients each, they aren't going to be able to effectively care for them," Andrews articulated.

Common physiological areas her team examines include heart rate, blood pressure, respiratory rate, and urine output, but the mental status of a patient is equally important. Mental status tends to be subjective, which makes critical care nurses invaluable because of their experience.

The success of the Hospital of Central Connecticut's MRRT program in reducing cardiac arrests by 62 percent is an example of using research data to improve patient treatment. Andrews is now analyzing data to see how this dramatic reduction in cardiac arrests impacts patient outcomes such as length of hospital stay and mortality.

"If the Medical Rapid Response Team program continues to show improved outcomes," Andrews continued, "the program will become a national standard of care, just as cardiac arrest teams are [standard] in acute care hospitals."

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