The document discusses the rapid response team (RRT) at Western Health in Victoria. It outlines the criteria for clinical reviews, rapid response calls, and code blue calls for deteriorating patients. It describes the RRT at Western and Sunshine Hospitals, which is nurse-led from 8am to 6:30pm daily. The ICU Liaison Nurse's role includes assessing patients prior to ICU discharge, following up ICU patients at risk, responding to rapid response calls, and daily rounding in clinical areas. Data shows rounding in new areas and the RRT have reduced unplanned ICU admissions and post-ICU mortality.

1. How we resource our
RRT
Western Health
Victoria
Anna Green
Manager ICU Liaison / RRT
Critical care nurse practitioner

2. Innovations passion for change
Often innovations can be found by looking at the same thing differently
“Think outside the MET”
Words can make a difference!! Video of the year! – YouTube

3. Western Health – Our Facilities
Western Hospital – 360 beds acute teaching hospital
Sunshine Hospital – 426 teaching hospital including women's and
children's service
Williamstown Hospital – 90 bed facility including emergency, rehab and
renal dialysis
Sunbury Day Hospital
Drug Health and Addiction Medicine – community based program.
Western Centre for Health Research and Education – run in partnership
with University of Melbourne and Victoria University.
Hazeldean Transitional Care

4. On a Typical Day at Western
Health
894
Patients
cared for
overnight
894
Patients
cared for
overnight
454
Patients see
a doctor in
outpatients
454
Patients see
a doctor in
outpatients
336
Patients
attend one
of our 3 EDs
336
Patients
attend one
of our 3 EDs
58
Surgical
operations
take place
58
Surgical
operations
take place
303
Patients are
discharged
303
Patients are
discharged
100
Patients
require the
service of an
interpreter
100
Patients
require the
service of an
interpreter
15
Babies are
welcomed
into the
world
15
Babies are
welcomed
into the
world
137
Volunteers
provide a
range of
services
137
Volunteers
provide a
range of
services
479
Patients
receive
community
and care co-
ordination
services
479
Patients
receive
community
and care co-
ordination
services
40
Patients are
visited at
home by our
Hospital in
the Home
Program
40
Patients are
visited at
home by our
Hospital in
the Home
Program
3027
Meals are
served
3027
Meals are
served

5. Western and Sunshine Hospitals
Three - Tier Response
1. Clinical Review – notify senior medical officer review (registrar or
above) Registrar to review patient within 30 minutes when
observations are in a orange area on the observation chart.
2. Rapid Response Call – notify the rapid response team when
observations are in an purple area on the observation chart and fill in
the ISBAR form. Rapid response provider to review patient within 15
minutes
3. Code Blue – medical attention required within 5 minutes call code blue
444

7. Making a clinical review call
•Oxygen flow rate ≥ 13 L / min
•Systolic BP ≥ 180
•HR in 40s range
•Temp > 38 or ≤ 35.4
•Consciousness to voice
•You are worried about the patient but they do not fit above criteria
If senior medical officer unable to review within 30 minutes then escalate
to a rapid response call

8. – Difficulty breathing
– RR > 30 or <9
– SpO2< 90% on oxygen
– HR > 120 or < 30
– Systolic BP < 90 mmHg
– UO < 60mL over 2 hours
– Consciousness to pain or unresponsive
Staff “worried” about the patient
Making a rapid response call

9. Making a code blue call
Respond Code Blue’ signifies a medical emergency/cardiac arrest.
Medical attention is required in 5mins: Code blue call 444
ICU Registrar
Critical Care trained nurse/s from CCU and/or ICU
ICU Liaison nurse
Medical Registrar
Anaesthetic/Pain Registrar
Ward Nursing Staff
Bed Manager/AHA
PSA
Other Medical Staff
Security
Surgical Registrar (nights)

10. Rapid Response Team
Western Hospital
Nurse led rapid response team (ICU Liaison Nurse)
Monday to Sunday 0800 to 1830 hrs
Unit Registrar and escalation to ICU Medical Registrar
Monday to Sunday Afterhours
Sunshine Hospital
Nurse led rapid response team (ICU Liaison Team)
Monday to Sunday 0800 to 1830 hrs
Some night duty cover 2000 to 0630 hrs
Unit Registrar and escalation to Anaesthetic Registrar
Monday to Sunday Afterhours
Williamstown Hospital
Code blue Call
Sunbury Hospital
000 Ambulance Call

11. ICU Liaison Nurse Role
1. Assess patients in the ICU prior to discharge and write a
comprehensive assessment using patient at risk score.
2. Provide follow up service for patients leaving ICU who meet ICU
follow up discharge criteria
3. Provide a nurse-led rapid response team review for
deteriorating patients
4. Minimum daily rounding to emergency departments and all
clinical areas at WH and SH

12. ICU Assessment using PAR score
ICU Discharge follow up
criteria
• PAR score >4
• ICU > 3 days
• Reportable vital signs
within 4 hrs
• Tracheostomy tube
181 (26.6%) reduction in post ICU patient reviews

13. Moving up the slope!
Patient
Condition
Time
Death
ALS
RRT
Clinical Review
The Slippery Slope
the Problem
Source: Dr Charles Pain
Rounding

14. Source of referral – Western hospital
2013
RRT referrals = 65.7%
Post ICU review = 34.3%

15. Post introduction of rounding in new
areas (emergency / maternity)

16. Number of unplanned ward
admissions to ICU pre and post
rounding

17. “The single biggest problem
in communication is the
illusion that it has taken
place.”

18. RRT Contact Details
Pager / Phone Rounding
NUM to be informed for both RRT and Clinical Review
Registrar to be contacted for a RRT call

19. 2013 Day vs Night comparison
• Mortality higher for
those admitted to ICU
afterhours
• 56% ward admissions
to ICU afterhours
• 16.5% of ICU
discharges afterhours

20. Time distribution for RRT calls
and reason for call
Top 5
1.Worried
2.BP < 90
3.HR >120
4.Sa02 <90%
5.RR >30

21. Time distribution for Code Blue
calls and reason for call
Top 5
1.Dec GCS
2.Worried
3.Airway
4.BP <90
5.Cardiac arrest

22. Advantages and Disadvantages
• Increased nurse referrals
• Continuity of care post ICU
• EOLC approx 15%
• Identifies issues with poor
management
• Career pathway
• Autonomy
• National database
• Educational level
• Position statement
• ‘Jack’ or ‘Jackie’ of all
trades
• No afterhours coverage
• Lack of secretarial support

23. RRT are on there way..........what do you do?