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TODAY news for Thursday, February 11, 2008

Loma Linda University Medical Center news

Recently implemented rapid response teams prove highly effective

Dale Isaeff, MD
Dale Isaeff, MD
Looking for some good news?

How about the fact that the three recently implemented rapid response teams at Loma Linda University have proven to be among the most effective live-saving interventions ever put in place at Children’s Hospital, the East Campus, and the Medical Center? 

“We have documentation that lives have been saved,” states Dale Isaeff, MD, chair of Loma Linda University Medical Center’s code blue committee. “We’re very pleased with the results!”

Each rapid response team (RRT) consists of three individuals—a doctor, nurse, and respiratory therapist—whose respon­sibility is to respond to any life-threatening or potentially life-threatening patient emergency situation that may arise in any of the non-ICU care areas in their respective hospitals on a 24/7/365 basis. Intensive care units are exempt from the purview of the rapid response teams, since they already have emergency personnel on hand.

Dr. Isaeff, who has chaired the code blue committee for the last 20 years, traces the development of the rapid response teams at Loma Linda University Medical Center to August 2005, when the first team was tested at Children’s Hospital. The results, as he suggests, speak for themselves: So far in 2007, there has been a 60 percent decrease in the number of code blue situations at Children’s Hospital over last year.

The statistic comes from Kelly Lumen, RCP, RRT, code blue process coordinator for Loma Linda University Adventist Health Sciences Center. As official compiler of statistics regarding the improvement associated with the rapid response team program, Ms. Lumen has also documented a 49 percent improvement over last year at the Medical Center, and an astounding improvement of 90 percent at the East Campus during the same period of time. Ms. Lumen measures the rates of improvement by comparing the number of code blue situations at each of the three participating hospitals.

Code blue emergencies require the administration of any, or all, of the advanced cardiac life support protocols recommended by the American Heart Association. Such protocols include ensuring adequate airflow to the lungs via an endotracheal tube, and/or a variety of cardiac interventions such as the injection of medications, and defibrillation, or shock treatment, when indicated.

Needless to say, anything that reduces the number of code blue incidents is a remarkable achievement, but the rates of improvement at Loma Linda University Medical Center indicate that the program has definitely proven itself in terms of lives saved. “It really is remarkable,” Ms. Lumen observes.

Dr. Isaeff notes that organizations which track statistics for code blue incidents at thousands of hospitals throughout the world have concluded that the sooner defibrillation is applied, the better the prognosis for the patient.

“It really is a situation of ‘shock first, ask questions later,’” he says. “The advantage of having a rapid response team is that the vital shock treatment can be administered to the patient much sooner than before.”

Dr. Isaeff buttresses the claim by pointing out that the rapid response team has greatly reduced the number of non-ICU patients developing acute distress. “With the RRT in place, the nurse can summon the team without calling an actual code,” he adds.

“This program is where Loma Linda University Medical Center really shines when compared to smaller hospitals,” he continues. “They have an emergency room physician on duty, but we’ll get you shocked and get a doctor to your bedside before their doctor can arrive on the scene because ours is on duty as a part of the rapid response team. The benefit to patients is that they get seen by a doctor much sooner; it nips the developing emergency in the bud.”

When Dr. Isaeff first ap­proached Medical Center administration about the idea of placing automatic external defibrillation (AED) units in non-critical care units, he found them open. “I got the impression,” he says, “that they were eager to do anything that might significantly improve the quality of care for our patients.”  But openness and money are sometimes two different things, so Dr. Isaeff was very pleased at the response he got when he asked for funding to purchase 13 AED’s.

“Dr. Behrens, CEO and president of Loma Linda University Adventist Health Sciences Center, came through with a grant for $39,000. The manufacturer threw in a 14th AED as sort of a baker’s dozen,” he notes.

Dr. Isaeff goes on to note that the AEDs have been so successful that there are now 43 of the units in operation at LLUAHSC.

While Dr. Isaeff speaks for the code blue committee, he is careful to acknowledge important contributions to the success of the RRT program by Cynthia Tinsley, MD, Eric Walsh Jr., MD, and Debra Craig, MD.

Ms. Lumen agrees. “Dr. Tinsley created the pediatric RRT at Children’s Hospital,” she notes. “Because of the impressive results and dramatic decrease in the number of code blue situations at Children’s Hospital, LLUMC administration requested that Dr. Isaeff proceed with initiating a rapid response team for the adult non-intensive care areas at the Medical Center. Dr. Isaeff charged me with the task of getting the Medical Center and East Campus teams up and running. At East Campus, Dr. Walsh was very willing to get involved and help create the team; Dr. Craig helped with the Medical Center team.”

In reviewing the progress of RRTs at Loma Linda, Dr. Isaeff notes that Children’s Hospital got things going by hiring physicians from their attending staff to rotate sleeping in house over­night at the hospital so they could be on hand for any pediatric medical emergencies.

“We were so pleased with the results,” he reports, “that we decided to extend the idea to the adult care programs at East Campus and the Medical Center. What we’ve found is that the rapid response team program has resulted in a documented reduction of codes and quicker re­sponse times for patients going into cardiac arrest.

“In another year,” he concludes, “the Joint Commission on Accreditation of Hospitals will require all hospitals to have RRTs in place. We beat the requirement by two years in our pediatrics team, and by a year in our adult team.”

By James Ponder

TODAY news for Thursday, February 11, 2008