Background: With the widespread implementation of rapid response system aimed at improving patient outcomes, providers are expected to perform the early detection, manage clinically deteriorating patients, and communicate effectively with rapid response teams (RRTs). Prior literature has reported that users of RRT described uncomfortable interactions, reduced clinical autonomy, role ambiguity, and a desire for improved knowledge and communication skills to be active participants during RRT events. However, effective RRT education approaches remain poorly understood. Our study aims to explore the experiences of hospitalists and Advance Practice Practitioners (APPs) in their interactions with RRTs and to determine if there are any perceived knowledge or communication gaps during RRT calls. This investigation is intended to inform the development of an educational curriculum targeting identified learning needs.
Methods: We administered an online RedCap survey via email to all hospitalists and APPs at the University of Chicago Medical Center in August 2023. Participation in the survey was anonymous and voluntary. The survey included seven demographic questions and ten RRT-related questions, which used a 5-point scale ranging from “never” to “always” or “strongly disagree” to “strongly agree”. Additionally, one multiple-choice question addressed factors contributing to lack of comfort during RRT calls. The study is exempt from IRB review. Wilcoxon signed rank test compared two groups, and ordinal logistic regression analyzed confidence levels in relation to years of experience or prior RRT experience.
Results: The response rate was 64% (48/75), comprising 91.7% hospitalists and 8.3% APPs. 54.3% providers had no prior RRT experience before starting their current position. 83.4% expressed confidence (“most of the time” and “always”) in managing unstable patients during RRT calls for their own service patients, while 50% reported confidence when managing cross-covered patients (p< 0.05). 89.4% of providers believed they effectively communicated the clinical situation to RRT members for their own service patients, compared to 48% when communicating about cross-covered patients (p< 0.05). 79.2% felt that they clearly understood their role. 50.1% felt a sense of loss of autonomy (“some of the time”, “most of the time” and “always”) over patient care to the RRT. Common contributing factors to lack of comfort during RRT calls included a lack of goals of care documentation, unfamiliarity with the patients during cross-coverage, and communication challenges with the Medical Intensive Care Unit team. 38.3% agreed that they would benefit from more clinical training in managing unstable patients, while 36.2% agreed that more communication training, specifically for RRT calls, would be beneficial. No statistically differences were observed when comparing confidence levels in responding to RRT calls with years of experience or prior RRT experience.
Conclusions: When designing a curriculum to enhance providers’ experiences with RRT calls, the focus should prioritize cross-coverage patient management, autonomy restoration, and communication between care teams. Given the finding of over half of the providers lacking prior RRT experience, simulation-based education during onboarding targeting new hires may effectively teach teamwork, communication, leadership and hospital system navigation to address the needs of providers that participate in RRT calls.