Published May 27, 2015 (revised July 15, 2024)
When people suddenly become sick or hurt at home or in the community, they or their families or friends can call 911 for emergency help. But what can a patient or family member do if they are at the hospital and feel their condition is getting worse and nobody is listening? Many hospitals today are allowing patients and families to call a healthcare team to the bedside if they have unaddressed concerns. These teams are called Rapid Response Teams (RRTs).
The idea is simple: any patient or family member can bypass the typical chain-of-command and call what is basically a medical "SWAT team" to quickly check out the patient and help when lifesaving care may be needed. A nurse or any other healthcare provider can also call the team. Most teams include a highly trained critical care nurse and a respiratory therapist, and many teams include a physician or nurse practitioner, and a pharmacist. Unlike the traditional “code” team that responds when a patient stops breathing or the heart stops beating (cardiac arrest),the RRT can help before these serious events occur. The goal of RRTs is to identify seriously ill patients, at-risk patients, and patients whose condition is suddenly worsening, and to activate an urgent response by healthcare providers who have the ability to deal with the emergency before the patient worsens or dies.
Almost twenty years ago, the University of Pittsburgh Medical Center (UPMC) Shadyside was perhaps the first hospital in the nation to invite patients and families to call for an RRT to address unresolved concerns about their safety and health (Thomson American Health Consultants. Condition H phone line provides last chance to prevent serious errors. Healthcare Risk Management. 2006;28[2]:13-17). Upon admission, patients and family members were encouraged to pick up any phone in the hospital to report a Condition H (for "help") if they:
Today, RRTs are widely used in hospitals. The general concept is sound—if we encourage all who observe the patient, including the family and patient, to call for help when needed, and if we send in a team of the right people with the right skills and knowledge at the right time, we should be able to rescue patients before their breathing or heart stops (cardiac arrest). There is evidence that allowing staff, patients, and families to call an RRT can save lives.
Several tragic deaths, about 25 years ago, had compelling factors that led to patient-and family-initiated RRTs. The first was the tragic death of an 18-month-oldchild, Josie King, who had been hospitalized for treatment of burns from a bathtub accident. Josie had been healing well, but she died 2 days before she was supposed to go home. Hospital staff failed to recognize that Josie had become seriously dehydrated. The child’s mother, Sorrel, was the first to notice her daughter’s desperate thirst. When the child saw a drink, she would scream for it. And when bathing, she would suck frantically on the wet washcloth. She then developed a fever and diarrhea—another cause of serious dehydration. When she became listless and her eyes rolled back in her head, Sorrel frantically tried to get help for her child because she felt something was not right. But in the end, the young toddler died of a third-world illness—dehydration—in one of the best hospitals in the world, despite repeated attempts by her mother to draw attention to the problem.
The other tragic death involved a previously healthy 15-year-old boy, Lewis Blackman. Lewis went into the hospital for elective surgery and died 4 days later from excessive blood loss caused by a serious side effect of his pain medicine. His mother, Helen, reported that her son was pale and was having severe pain in his stomach. She thought the stomach pain was unusual given that the surgery was to his chest area. Lewis developed a high fever, low blood pressure, very pale and cold skin, and many other signs of internal bleeding and medical decline. The boy’s mother repeatedly insisted that her son be checked by a veteran doctor, rather than the new residents on duty over a weekend, because she knew something was very wrong with her son. But her repeated demands were never honored. Lewis died from internal bleeding caused by an ulcer in his stomach, a known and serious side effect of the pain medicine, ketorolac, he was receiving.
Sorrel King and Helen Blackman have no doubt that access to an RRT could have saved their children, as the errors that caused their deaths were preventable and detectable. Likewise, we have no doubt that a patient- or family-activated RRT could have lessened the harm that has resulted from other life-threatening and deadly medication errors.
Take one of the very errors that helped spark the modern patient safety movement—an overdose of chemotherapy given to Betsy Lehman in 1994, which brought widespread public attention to medical errors. Betsy received an entire course(4 days’ worth) of chemotherapy each day for 4 days in a row. Both Betsy and her husband repeatedly expressed that something was very wrong after the first dose, but their concerns were dismissed as common side effects from chemotherapy. Sadly, on the day she was to be discharged, Betsy even phoned a friend and left a message, "I'm feeling very frightened, very upset. I don't know what's wrong, but something's wrong" (Lehrer S. Epilogue to: Explorers of the Body. 1979; Doubleday; page 439). She died an hour later. If Betsy or her husband had been allowed to call an RRT when Betsy first experienced symptoms of the overdose, would she have survived? A different group of health practitioners whose primary role was to listen and be objective and responsive very well might have resulted in a better outcome if the error had been caught when Betsy and her husband first expressed concerns.
Here's what you can do: Allowing patients and families the ability to summon an RRT may be one of the most significant ways that healthcare providers can make patients partners in their care and safety. Consider the following recommendations to protect yourself and your family from accidental harm while hospitalized.
Educate yourself. Learn about the disease, medical tests, and the treatment plan for you or your hospitalized family member. Also learn what medicines are being given and for what reason, the prescribed doses, when and how they are given, and common side effects. Write down important information. A patient or family member who knows what to expect can help recognize when something is not right.
Ask how to call an RRT. When admitted to a hospital, ask whether patients and families can call an RRT and under what conditions such a call would be appropriate. Be sure you and your family knowhow to activate an RRT.
Report what worries you. Report anything that worries you or does not seem right with you or your family member. Do not be afraid to speak up. Although doctors and nurses are highly trained regarding your medical condition, or your family member’s condition, you know yourself and your family better than anyone on the medical team. Your observations are extremely important.
Ask questions. If you have questions about your care or family member’s care, you need to ask. Also, if you do not understand the answer you get, you need to ask again.
Be persistent. Keep asking questions or voicing your concerns about your condition or care, or your family member’s condition or care, until you get an answer that makes you comfortable.
Activate an RRT. If you feel no one is addressing your concerns, do not hesitate to call an RRT using the directions provided upon admission. If the hospital does not offer an RRT, ask to speak to the doctor in charge (medical director), nurse in charge (nursing director),and the patient representative.
Speak up about the care provided. If you believe something is not being done correctly—perhaps a medicine or medicine dose does not seem right—do not be afraid to speak up. Healthcare professionals are human; they could make a mistake. Sadly, patients, families, and healthcare providers often live with regret because they did not follow through on a suspected problem. The lesson they want to share with all is to speak up and be persistent, even if there is just a hint of a potential safety issue.
