The Joint Commission on Accreditation of Healthcare Organizations' new 2008 patient safety goal of requiring a process to respond quickly to a deteriorating patient is being mistakenly interpreted at some hospitals as a mandate for rapid response teams or medical emergency teams, while other organizations that already have rapid response teams are concerned they will need to redo their established systems.
But Dr. Peter Angood, vice president and chief patient safety officer for the Joint Commission, said such presumptions are incorrect—hospitals are simply being asked to select a “suitable method” that allows staff to request assistance from a specially trained individual or team when a patient's condition seems to be worsening.
The key is to focus on early recognition of a deteriorating patient and the mobilization of resources and to document the success or failure of the system that is in place, he said. “This is not a goal that states there needs to be a rapid response team.”
Many institutions have implemented rapid response teams, and the data on their efficiency is generally good, but not every study has been positive, Dr. Angood said. As a result, officials at the Joint Commission wanted to move forward with a more basic approach to avoid variation in response from day to day and between shifts. (See box.)
Hospitalists are likely to play a significant role in accomplishing this goal, said Dr. Franklin Michota, director of academic affairs for the department of hospital medicine at the Cleveland Clinic.
Those with hospitalist programs in place are leaning toward using rapid response teams or medical emergency teams, because hospitalists can function as team members. Some hospitals that do not have enough staff to have a 24-hour team in place are considering starting hospitalist programs. Yet another strategy is to form teams that do not include physicians, he said.
But the requirement will not be without cost, Dr. Michota said, especially for organizations that have to add staff.
When hospitalists aren't a part of a response team, they are likely to be central to developing the response plan, said Dr. Robert Wachter, chief of the division of hospital medicine at the University of California, San Francisco. Perhaps the biggest role for the hospitalist is in providing the around-the-clock coverage that could negate the need to call the formal response team as often, he said.
Brock Slabach, senior vice president for member services at the National Rural Health Association, argued that smaller organizations might be able to meet the commission requirements more easily than large, urban facilities can, because they are more flexible and can work faster because there is less bureaucracy.
A number of hospitals have already made a commitment to establish some type of rapid response teams, which is one of the strategies advocated as part of the Institute for Healthcare Improvement's 5 Million Lives Campaign, a national patient safety campaign for reducing harm in hospitals.
Of the 3,800 hospitals enrolled in the 5 Million Lives Campaign as of January, about 2,700 have committed to using rapid response teams, according to the IHI.
The cost of implementing these types of teams varies, said Kathy Duncan, R.N., faculty for the 5 Million Lives Campaign. About 75% of hospitals in the campaign have done this without an increase in their full-time employees, because for most staff, it just entailed an additional task. But investment is required for training team members, which can be costly, she said.
Ms. Duncan said hospitals should start by assessing their available resources, then before implementation, they should test the process. “Start small with a pilot process,” she advised.
Implementing the Response Plan
Because of the complexity of implementing a process to respond quickly to a deteriorating patient, officials at the Joint Commission are giving hospitals a year to develop and phase in their program.
By April 1, the first deadline, hospital leaders were required to assign responsibility for the oversight, coordination, and development of the goals and requirements. By July 1, there needs to be an implementation work plan in place that identifies the resources needed. By Oct. 1, pilot testing in one clinical area should be underway.
The Joint Commission is serious about organizations meeting these implementation milestones, Dr. Angood said. Hospitals that don't meet the quarterly deadlines will be docked points on their evaluation.
For 2009, hospitals will need to comply with the following six “implementation expectations” set out by the Joint Commission:
▸ Select an early recognition and response method suitable to the hospital's needs and resources.