We've had rapid response in house now for close to two years. Preliminary results for own our institution show a substantial decrease in the amount of codes. During the day, a critical care or hospitalist attending along with a critical care nurse, pharmacist and respiratory therapist usually comprise the rapid response team. The in-house senior resident on medicine consult is also expected to come to all rapid responses. At night, the attendings aren't in house, but a senior critical care nurse is. On call residents are expected to come to rapids responses at night.
The RRT should be looked at as an extra pair of hands and as a mechanism for simulating ICU level care on the general floor. It also helps in securing an open bed in the ICU and cuts down on the wait time and workload of the on call resident in transferring a patient to the ICU. When RRT works well, the primary intern and/or resident on call runs the rapid response and delegates tasks to the rapid response team. The attending present sits quietly beside the resident running the RR and offers suggestions, approvals, or polite disagreements. When it runs poorly, primary residents arrive sheepish and the RRT dominates the decision making process while leaving out the members of the team who know the patient best.
I've seen it work fantastically and badly. It often mostly relies on the personalities of those on the team. Overall, I think RRT have been great additions. Most of us (residents) actually feel like we aren't getting enough code experience but feel very well versed in managing hypoxia, hypotension, SVT, VT, AMS, etc.
Now, though, when a rapid response is announced over head, the residents in the ICU cringe.
(based on optimal staffing guidelines for a medical/surgical floor) I know many hospitals don't follow optimal ratios.
