Background: Rapid response teams play an important role in the care of clinically deteriorating patients. Variability in team members, setting, and activation criteria creates unique challenges to studying these teams. The complexities and inefficiencies of rapid responses due to their heterogeneity are poorly understood. Here, we explore opportunities for improved rapid response team efficiency using focused ethnography.
Methods: We conducted a focused ethnography of rapid response teams at one urban, academic medical and trauma center to better understand the complexities of rapid responses teams and identify opportunities for improvement. We used standard, established ethnographic methodology including participant observation, fieldnote analysis, and formal and informal interviews. A total of 36 rapid response teams were observed over the course of seven weeks during both day and night shifts to achieve data saturation. Transcripts and field notes were analyzed for themes using a grounded theory approach.
Results: Five distinct stages of rapid response progression were noted and described: trigger, arrival of team, gathering information, plan implementation, and conclusion. Rapid response progression was inhibited by team and system mechanics such as unpredictable arrivals of team members, clinical heterogeneity, and lack of necessary decision-makers at the bedside. Conversely, rapid response progression was often favorably influenced by group dynamics such as interpersonal familiarity, trust and rapport, positive emotions within the room, and clinician experience level. Key communication behaviors improved rapid response team efficiency including: role clarity and leader identification, keeping the team “on the same page” during transitions, and cohesive call conclusion.
Conclusions: Rapid responses represent a complex clinical care setting influenced by team, system, and group dynamics. Insights gained in this study may be useful to inform core skills necessary for rapid response team members as well as interventions aimed at process improvement.