Patient-activated RRTs Catch On Around the U.S.

A growing trend in U.S. hospitals that allows patients and their relatives or loved ones to activate a rapid response team (RRT) under certain conditions is winning acceptance from hospitalists nationwide.

The practice was started in May 2005 at the University of Pittsburgh Medical Center (UPMC) after an 18-month-old girl died from narcotic misuse, dehydration, and a breakdown in communication.

The child’s mother told hospital officials that if they had a patient-family initiated RRT, she believed her daughter would be alive today. An official with the hospital’s Center for Quality Improvement and Innovation (CQII) agreed, and a study of the practice was under way.

Within months, the UPMC decided to put the plan—called Condition H (for Help)—into practice. Sue Martin, RN, with the center’s CQII, calls Condition H “a corporate function that supports all of the [19] hospitals in our health system.”

Today there are some 20 hospitals in the U.S., besides those in the UPMC system, that have instituted a version of the plan. More will soon, having read or heard about the success UPMC says it’s having.

“When we first started doing it, people wondered why we would let the patient or visiting relatives activate the rapid response team, since they were nonprofessionals,” Martin says. “But after it was explained to them and they were told of its success, they accepted the concept.”

She says UPMC began getting inquiries—and still does—every month from hospitals and others in the medical community asking how the plan works. They ask if UPMC would teach them about Condition H, Martin says.

“We’ve been doing that ever since,” she says. “Look, things are not perfect in the health system, but we’re fixing them. And as we do, we need a community to help keep our patients safe.”

Just about the time UPMC began its patient-activated RRT in May 2005, the Greater Baltimore Medical Center (GBMC) followed suit.

Letters

CLARIFICATION OF THE COCKROFT-GAULT EQUATION

I applaud the recent article on dose adjustments in elderly patients (January 2008, p. 14). Physicians have not paid enough attention to this issue, resulting in undo expense and side effects in patients with renal insufficiency.

However, I would note that the version of the Cockroft-Gault Equation used by pharmaceutical companies in their studies and dosing recommendations uses ideal body weight (IBW) rather than actual weight. The equation as quoted in the article may result in an overestimation of the dose adjustment based on a drug company’s recommendation. This topic is covered in detail in other articles, but the Cockroft-Gault Equation using IBW follows:1,2

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