681: Clinician Perceptions of a Pediatric Rapid Response Team Program

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Introduction: Rapid response teams (RRTs) were developed to improve early recognition and response to patient deterioration outside the ICU. Our organization, a large academic children's hospital, instituted a rapid response team (RRT) in 2007 and sought to evaluate clinician perceptions and barriers to the program. Methods: In 2010, 3 years after implementing our RRT program, an anonymous on-line survey was conducted with clinicians (including physicians, mid-level providers, and nurses) on our inpatient units that utilize our RRT. In this baseline survey, staff identified multiple barriers to using the RRT. Organization wide communication training occurred in 2011. Over 2400 clinical staff received training on situational communication strategies including SBAR (Situation, Background, Assessment and Recommendation) and assertion training. In 2011, a practice change was implemented requiring a mandatory RRT for a pediatric early warning score that reached a specified level. In 2013, staff were re-surveyed with the same 2010 questionnaire in order to assess effectiveness of these strategies in reducing barriers to the RRT. Results: In 2010, 325 clinicians completed the RRT survey compared to 362 in 2013. Staff were more likely to notify a senior physician and/or call an RRT when they had concerns about a patient and were in disagreement with plan of care (56.9% and 55.8% respectively) in 2013 than they were in 2010 (36% and 47.4% respectively). 70% of staff in 2010 were comfortable escalating concerns if others disagreed as compared to 75.1% of staff in 2013. Satisfaction with current RRT process increased for both staff RNs (85% in 2010 to 92.5% in 2013) and attending physicians (78% to 85%). In 2010, 30% of staff reported they encountered a negative response from another staff member when requesting an RRT and 37% identified lack of support. In 2013, 24.3% reported a negative response and 23.4% reported lack of support. Fear of appearing as if they did not know what they were doing and fear of reprimand were reported less in 2013 (27% to 15.6% and 12% to 7.6%, respectively). Communication concerns amongst disciplines decreased from 50% to 26.8% in 2013. Conclusions: Organizations should evaluate staff perceptions of their RRT in order to target efforts to reduce barriers to its use. After implementing situational communication training and a mandatory RRT for signs of clinical deterioration, our organization saw a reduction in reported barriers to the RRT.

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