Background: The hospitalist role has traditionally been within the hospital setting where a dedicated Rapid Response Team (RRT) and critical care support are available to respond to acute clinical events. While hospitalist involvement in RRT/Codes can vary by institution, the academic hospitalist is infrequently the RRT/Code team leader. As the hospitalist’s scope expands to new environments outside of the traditional hospital setting, forums for continued faculty development in this area are increasingly prudent. Simulation training is one such forum, which can lead to improvements in self-reported RRT performance. 1
Purpose: In late 2023, our health system opened an off-site, state-of-the-art inpatient facility for our behavioral health patients. In anticipation of our academic hospitalist group providing medicine co-management and RRT/BLS coverage without internal medicine trainee or critical care backup, we developed a targeted behavioral health RRT curriculum with simulation training. We aimed to standardize best practices in RRT management and familiarize our faculty with the most common critical scenarios to expect.
Description: The experience level among our 30+ faculty hospitalist group varies between 1-25 years post-residency training. An anonymous pre-intervention survey revealed that 46% of respondents disagreed / strongly disagreed when asked if they felt confident leading an RRT/Code while another 19% responded indifferently. Not surprisingly, respondents who were closer to residency training (< 5 years since graduating) reported feeling more confident. Our first intervention was a faculty educational conference to provide an overview of the indications and outcomes of past behavioral health RRTs at our institution and review the management of common RRT scenarios. The educational materials were also made available for independent review on a shared drive file. Our second intervention was to offer elective in-person simulation RRT training. Preliminary post-intervention survey data suggest that a faculty development conference to review the expectations and management of typical RRTs was an effective means of building RRT confidence, with 86% of respondents in agreement / strong agreement. All of the respondents who attended the in-person simulation training agreed /strongly agreed that the training improved their RRT confidence. We also observed that in-person simulation RRT training further augmented the positive effect of the faculty didactic on self-reported RRT confidence. Both learning modalities appeared effective at increasing faculty confidence in leading an RRT regardless of experience level.
Conclusions: Hospitalist confidence and familiarity with running RRTs can wane without continued exposure and practice. Maintaining competence in critical event response is increasingly essential for today’s hospitalist, whose clinical scope can easily extend beyond the traditional hospital setting. We found that multi-modal RRT training with both didactics and in-person simulation can be synergistic in building RRT confidence regardless of years of experience post-residency training. Next steps include a longitudinal survey to assess the durability of self-reported RRT confidence and an analysis of the impact of our RRT curriculum on clinical outcomes.