Nurse Response Teams and Escalation

Slides by Alex Ryden, Brian Locke, and collaborators

Nurse Response Teams and Escalation

At IMC, a floor nurse can call an experienced ICU nurse for help: the Emergency Response Team.

Ways this can help residents

  • Repeated contact through the shift builds trust.
  • Opportunity for introduction and team building.
  • Experienced information gatherer.

Ways this can work poorly

  • Disagreements about management.
  • Multiple nurse contacts.
  • Late RRT activation.

RRT at T1010: Emergency Response Nurse called

  • Blood pressure low.
  • Fluids running.
  • Patient now confused.

Prompt: How do you approach the situation?

Strategies for working with ERT

  • Early introduction in shift.
  • Elicit story and concerns.
  • Add synthesis.
  • Recognize trajectory/resources.

Rapid Responses: When to Escalate?

  1. Decide where the patient needs to go.
  2. Consider if you have everything you need.
U of U IMED VA
RRT/MET House Sup, IM Res, SICU RN, Pharm IM, CICU RN, Nurse Sup, Pharm, RT, EKG, ABG, Lab IM, MICU, CNO, RNs, RT, Pharmacy (7a-7p)
Code Blue add: Anesthesia, EMT, MICU resident, Pharm, ICU Fellow add: ICU attendings add: Anesthesia/ED
Numbers Shock Team, Cath, Brain Attack, VAD: 1-2222 Shock Team: Vocera TICU attending; Brain Attack: Operator/x33333 Brain Attack: Page Neuro Senior; Cath: Page Cardiology; Code: x6666

VA RRT case

Elderly man, immediately hypoxemic after transfusion.

RR 24. SpO2 82% on 2 L.

Now worsening: tripoding, accessory muscle use, 100% FiO2 face mask, SpO2 upper 80s.

XR Chest Obtained During RRT

Prompt: What needs to happen?

Call resources early

Signal Action
Oxygenation or airway failure RT/CC/anesthesia
STEMI/cath physiology Cath
Focal neuro deficit Stroke
Shock, PE, VT storm, device question Shock/PERT/TICU by site

Code risk: bed out/down, pads on, airway/CPR access clear.

Rapid endpoint

Goal = right stabilization and dispo, not full explanation.

  • code blue
  • ICU transfer
  • rarely, a procedure
  • stabilized on the floor
  • goals-of-care transition

Always hand off to the team assuming care.

Summary

  • Emergency Response Team model.
  • Early introduction.
  • Decide where the patient needs to go.
  • Consider what resource or capability is missing.

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