Background: Rapid response teams (RRT) are critical to the timely and appropriate management of acutely decompensating patients within many hospital systems. In the academic setting, the vital role of RRT leader is often filled by a resident physician who may lack the necessary medical knowledge and experience to initiate timely management for these patients. 100% of first year Internal Medicine residents surveyed at our institution did not feel confident in their ability to lead a rapid response, with their most common concern being medical knowledge. Cognitive aids have been shown in many studies to improve leader performance during medical emergencies; however, a standard RRT cognitive aid is not yet widely available. With the increase in use of mobile smartphones in patient care, a digital, app-based cognitive aid offers an optimal platform for a widespread, easily accessible rapid response toolkit.
Purpose: We aimed to create a digital, app-based rapid response toolkit to improve RRT leader performance and patient outcomes by providing immediate management cues and other time-sensitive content.
Description: To design our toolkit, we first interviewed RRT leadership and reviewed RRT records at the two academic hospitals within our healthcare system to identify the most common reasons for RRT calls. We identified four primary categories to serve as the main selection menu in the toolkit: altered mental status, shock, respiratory distress, and arrhythmia. In creating our toolkit, we incorporated aspects of successful cognitive aid designs from the existing literature and created content based on society guidelines and local expert consensus. Each section features an approach to undifferentiated management that includes initial stabilization, recommendations for laboratory and diagnostic studies, differential diagnoses, relevant time-sensitive drug dosages, and next steps for high-stakes diagnoses. There are also subsections within each category that provide direct links to diagnosis specific pages, a master drug list, and resource suggestions. Additionally, we included a cardiac arrest section with ACLS guidelines, and an “Emergency Response Teams” section with institutional resource contact numbers and policies. We published the rapid response toolkit within OCCAM (Online Clinical Care Advisories and Messages), a mobile and web application available through our institution’s network. OCCAM is used widely by trainees, faculty, and staff at our institution and allowed us to distribute our toolkit widely and efficiently.
Conclusions: Our rapid response mobile app-based toolkit provides emergency specific content to facilitate timely and appropriate management by RRT leaders. Our toolkit’s content is applicable to multiple specialties and contains key emergency response guidelines to promote a shared mental model within interdisciplinary RRTs. Additionally, our toolkit is readily available as an educational resource to prepare resident physicians and other RRT members prior to these events. Future work is needed to explore RRT leader performance and patient care outcomes with the use of our application.