Background: Active patient engagement improves patient outcomes. Patient activated rapid response teams are one potential method to encourage patient involvement, however outcomes of this intervention have not been evaluated. The University of Pittsburgh Medical Center developed and implemented a patient and family initiated rapid response system called Condition Help. All hospitalized patients are educated at admission about Condition Help by print and electronic formats. Once activated, a patient care liaison, administrator on duty, and charge nurse convene at the bedside to address patient concerns. We describe the characteristics and outcomes of patient activated rapid response calls.
Methods: Condition Help events from January 2012 through June 2015 were reviewed. Basic demographic information, admissions per year, initiator and timing of calls were obtained for each patient involved. Reasons for calls were differentiated into one of ten categories which included concerns regarding pain control, staff, communication, medical management, delays in care, service, discharge, administrative issues, acute psychiatric needs, and unknown. These were furthered stratified into primary satisfaction versus patient safety issues. When available, outcomes were assessed based on whether changes in care plan were made during the code or escalation of care occurred during admission.
Results: A total of 367 Condition Helps were called by 240 patients and/or family members. The majority of patients were female (62%) and Caucasian (70.8% vs 25.8% African American) with average age 45 years. Most rapid responses were initiated by patients rather than family members (76.8% vs 21.7%) with equal distribution between days of the week and daytime versus afterhours. 43 patients (18%) were involved in multiple calls and accounted for 47% of all events. Nearly half of codes were called for inadequate pain control (48.2%) followed by dissatisfaction with staff (12.5%) and relatively equal distribution amongst other categories. Changes in care were made in 51% of events. The primary reason of activation related to patient satisfaction rather than safety (90.7% vs. 5.1%). Escalation of care with activation of a traditional rapid response or transfer to the ICU occurred during admission in 8.7% of patients.
Conclusions: Of the 3.5 years reviewed, most events were called for reasons of patient satisfaction rather than safety. However changes in the care plan were made as a result of calls for half of the events, illustrating that Condition Help may provide patients with an improved ability to influence their care plan. Our experience suggests that patient and family initiated rapid response teams allow for enhanced patient engagement, communication and possible improvements in the safety of care delivered.