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Tensions around quality improvement

The impact in hospitals of rapid response teams

September 2012

Published in the September 2012 issue of Today’s Hospitalist

When is quality improvement too much of a good thing “and when does hospital culture get in the way of improving quality? Those are questions we consider this month in our analysis of rapid response teams (RRTs).

Once upon a time, RRTs were viewed as everything that was right about quality improvement efforts. The teams could not only reduce the number of patient codes, the thinking went, but reduce mortality, all by tapping into the expertise of physicians already on staff at hospitals.

Over the years, however, studies have suggested that despite their reputation, RRTs didn’t actually improve mortality rates or patient outcomes.

Our story explores another RRT dimension. When researchers in one academic center looked at how RRTs affected the medical staff, they found conflicting data.

Nurses, who were the ones calling the RRTs, generally liked them. Hospitalists heading up the teams similarly enjoyed the acuity of the cases they treated.

But hospitalists noted that the teams wreaked havoc on their schedules, and some housestaff felt like they were pushed out of the way when RRTs arrived. Researchers also found that the hospital needed to do away with some of its top-down (think: physician-down) decision-making to embrace the idea of nurses acting independently.

That’s not to say that the RRTs didn’t produce benefits. But those gains really kicked in once the hospital addressed many of the tensions that erupted when an RRT was called.

As American medicine embraces health care reform “and initiatives to improve the quality of care proliferate “I wonder if physicians (and nurses) will soon have similar tales to tell about the unintended consequences of QI efforts.

Those initiatives have the potential to improve health care. But how will they affect your workload, morale and stress?

edoyleEdward Doyle
Editor & Publisher