Wendy Clayton is the Clinical Program Coordinator at Penn State Health St. Joseph. In her role, Wendy enculturates evidence-based practices for disease management using collaborative interdisciplinary strategies, quality improvement initiatives, and performance analytics. She aims to improve patient outcomes and organizational quality across the care continuum.
Abstract
Key Words: rapid response team, interdisciplinary team, simulation training, organizational culture, patient safety, inpatient mortality, collaboration, coaching, patient outcomes, failure to rescue Management of rapid patient deterioration requires prompt recognition and swift response by bedside nurses and specially trained personnel...Management of rapid patient deterioration requires prompt recognition and swift response by bedside nurses and specially trained personnel, who successfully intervene to improve patient outcomes. Appropriate recognition and initiation of life-saving interventions depends heavily on the competencies, skill sets, and experiences of the bedside nurse (Dobuzinsky, 2017). The advent of rapid response teams (RRT) mobilized critical care interventions to the non-intensive care patient, in order to mitigate in-hospital mortality and morbidity. In 2004, the Institute of Healthcare Improvement (IHI) identified the need for rapid response mechanisms for patient deterioration as essential healthcare to abate in-patient mortality and improve patient safety (IHI, 2017a). The Agency for Healthcare Research and Quality (AHRQ) and the IHI stressed the importance of timely recognition and activation of RRTs as indicators for optimal patient outcomes (AHRQ, 2017b; IHI, 2017b; Patient Safety & Healthcare Quality, 2005). “Failures in planning and communication, and failure to recognize when a patient's condition is deteriorating, can lead to failure to rescue and become a key contributor to in-hospital mortality” (IHI, 2017b, n.p.). Nursing shortages, poorly developed educational activities, and insufficient organizational safety practices contribute to delayed responsiveness to deteriorating patients by bedside nurses (Subbe & Welch, 2013). Delayed intervention results in patient demise and disability, as well as increased financial burden for the patient and the organization (Chan et al., 2008; Leach & Mayo, 2013). Precise, swift execution of care for the rapidly deteriorating patient requires bedside nurses to exercise clinical judgment and confident actions to improve patient outcomes. The advent of rapid response teams (RRT) mobilized critical care interventions to the non-intensive care patient, in order to mitigate in-hospital mortality and morbidity.This article offers a brief background of rapid response, including the supporting theoretical framework. Also discussed are barriers to nursing action that result in synergistic imbalance, including: bedside nurse competence to recognize patient deterioration and activate rapid response systems; bedside nurse clinical judgment; interdisciplinary teamwork; and organizational culture. The article includes implications for practice aims to address identified barriers and improve patient outcomes. BackgroundEarly detection and prompt mobilization of resources reduces the number of deaths outside of the intensive care unit Bedside nurses provide continuous observation and assessment of hospital patients. Optimal patient outcomes center on the detection of subtle changes in patient condition and the subsequent actions taken by bedside nurses (Chan et al., 2008; White, Scott, Vaux, & Sullivan, 2015). Timely recognition requires vigilance and astute assessment from bedside nurses, as well as confident engagement with higher-skilled colleagues. Timely recognition and activation calls for balancing the patient’s complex healthcare needs with the nurse’s skills and competencies (Angel et al., 2016; Dobuzinsky, 2017). Early detection and prompt mobilization of resources reduces the number of deaths outside of the intensive care unit (ICU). However, the challenge rests in the identification of the subtle signs of a deteriorating patient by the bedside nurse and subsequent activation of the response team (AHRQ, 2017b; Dobuzinsky, 2017; Tait, 2010). This article identifies barriers impeding nurse activation of rapid response teams for clinically deteriorating patients and proposes recommendations for future practice. Theoretical FrameworkBarriers that affect patient care indicate failed synergy between patient needs and nurse skills.Healthcare complexities are vast and rapidly change in the current environment. Increased patient needs and acuity, resulting from medical advancements, are extending life expectancy. Patient and family preference regarding end-of-life options also impact life expectancy. As a result, nurses may be unprepared to address increasing demands of patient physical, psychological, and spiritual needs. Bedside nurses, typically unprepared in critical care interventions, will need to expand their competencies along a continuum of practice, further developing clinical decision-making skills to prepare them for complex situations (Petiprin, 2016). “Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse’s competencies” (AACN, 2017, n.p.). The American Association of Critical Care Nurses (AACN) Synergy Model for Patient Care balances patient needs with nurse competencies to optimize patient care and outcomes (Hardin & Hussey, 2003, p. 73). This theoretical framework serves as the foundation to identify the barriers that affect a nurse’s ability to recognize patient deterioration and appropriately activate RRTs. Barriers that affect patient care indicate failed synergy between patient needs and nurse skills. The AACN Synergy Model for Patient Care provides five assumptions to guide patient care and eight patient characteristics which determine patient vulnerability and condition (AACN, 2017; Hardin & Hussey, 2003). The assumptions, as shown in the Table, describe the context for patient care through the identification of holistic complexities, relationships, and defined goals for wellness. Fidelity to the patient’s desires and needs warrants review of his or her ability to manage the spectrum of characteristics that influence health outcomes. Table 1. Patient Characteristics Guiding Patient Care
(AACN, 2017; Hardin & Hussey, 2003) The bedside nurse’s ability to identify and assess patient characteristics facilitates timely response and acknowledgement of appropriate interventions for rapidly deteriorating patients. However, this is only one half of the equation. Synergy necessitates a combined effort and link between the patient’s needs and the nurse’s ability. Nursing care competencies for optimal patient outcomes exist on a continuum of care and are prioritized based on the patient circumstances and condition (Hardin & Hussey, 2003). Nurse competencies include: clinical judgement; advocacy and moral agency; caring practices; facilitation of learning; collaboration; systems thinking; response to diversity; and clinical inquiry (AACN, 2017). Failure to respond to the clinical signs of deterioration compromises patient outcomes potentially increasing in-hospital mortality and morbidity.Gaps in clinical judgment and clinical inquiry cause failures in nurse responsiveness to signs of patient deterioration (Astroth, Woith, Jenkins & Hesson-McInnis, 2017; Chan et al., 2008; Dobuzinsky, 2017; Garvey, 2015; Parker, 2014; Tait, 2010). Failure to respond to the clinical signs of deterioration compromises patient outcomes potentially increasing in-hospital mortality and morbidity. These missed opportunities may relate to the incongruence between patient needs and nurse competencies. Attaining balance between these needs and competencies yields better patient outcomes through appropriate nursing interventions. Barriers to Nurse ActionsResearch suggests that patient deterioration occurs within hours of a change in level of care... Ineffective training and clinical judgment, cumbersome processes and teamwork, and a poorly developed organizational culture of safety are barriers that affect nurses’ abilities to appropriately manage patient assignments. Bedside nurses provide continuous surveillance of the patient’s condition, thus anticipating and/or predicting changes signaling decline (Benner, 2001). Research suggests that patient deterioration occurs within hours of a change in level of care, whether admission to an inpatient unit from the emergency department or a transfer from the intensive care unit or surgical suite (Walston et al., 2016). Heightened awareness and observation of these patients require appropriate staffing levels to support the bedside nurse’s ability to monitor and trend changes in a patient’s condition (Wakeam, Hyder, Ashley, & Weissman, 2014). Beside nurses must not only monitor and trend changes, but also appropriately identify when changes in a patient’s condition warrant attention. To correctly identify deviations in a patient’s baseline condition, bedside nurses must exercise critical thinking and clinical judgment congruent to the patient’s condition. Additionally, clinical relationships and team performance influence the actions and/or inactions of the bedside nurse. At times, these relationships reflect a deep chasm between organizational culture and patient safety. In combination, poor clinical judgment, fragmented teamwork, and a weak organizational culture for patient safety impedes appropriate action by bedside nurses for their patients. Clinical Judgment Factors Novice bedside nurses describe feeling worried or concerned for their patients, stating “something is wrong,” but are unable to clearly articulate or describe patient changes (Tait, 2010). Inexperience, coupled with an inability to connect perceptions with clinical findings, suggests unbalanced synergy and creates discord between experienced team members, physicians, and novice nurses, thus further disrupting effective and efficient team intervention. Intuition is vital to nursing judgment and clinical decision-making as it integrates emotional and physical awareness with spiritual connectedness between nurse and patient (Michael et al, 2015). The AACN Synergy Model for Patient Care illustrates that unbalanced synergy destabilizes the relationship between the nurse’s abilities and the patient’s condition, threatening poor outcomes resulting from inappropriate intervention. Hesitation and uncertainty from bedside nurses not only jeopardize patient outcomes, but also compromise clinical relationships. Clinical Relationships and Teamwork Indifferent responsiveness from RRT team members to activation of the team response by bedside nurses perpetuates about attitude of distrust and skepticism... Indifferent responsiveness from RRT team members to activation of the team response by bedside nurses perpetuates about attitude of distrust and skepticism among healthcare professionals. Gender roles and job titles influence relationships within a team and, as a result, beside nurses describe feeling inferior to advanced skill nurses, thus limiting appropriate responses or interventions by bedside nurses (Speck, Jones, Barg, & McCunn, 2012). Hierarchical structures have the potential to emphasize disharmony between roles and positions affecting the “psychological safety” of an organization (Wakeam et al., 2014). Disruptions in the psychological safety of an organization undermine clinical judgment, dissuade empowerment, and negatively influence organizational culture. Organizational Culture Synergy fails without robust clinical judgment, effective teamwork, and organizational safety culture. Implications for Future PracticeNurses are expected to achieve and maintain high-levels of competency regarding recognition of deteriorating clinical signs in patients (Waldie, Tee, & Day, 2016). Globally, healthcare organizations are improving the nurse’s ability to recognize and respond to changes in patient condition through investment of human resources and financial support for education (Astroth et al., 2017). Supporting novice nurses, and those with limited clinical experience in clinical assessment, is essential to improve patient outcomes (Parker, 2014). Synergy between bedside nurse competencies and patient needs or demands creates an optimal healthcare environment. Most bedside nurses, including those in specialty areas such as pediatrics or psychiatry, require advanced training and simulation modules focused on the early warning signs and symptoms of patient deterioration (Manu et al., 2015; Roberts et al., 2014). Future implications for nursing practice include dynamic, multimodal education strategies, robust team relationships, and organizational safety culture. Supporting novice nurses, and those with limited clinical experience in clinical
assessment, is essential to improve patient outcomes Enhanced Education Strategies Multimodal education components allow for deep connectivity between skill development and knowledge, thus creating a bridge to practiceCompetency mastery is achieved through simulation training, demonstrated in preceptor-paired activities, and established with clinical pathways and evidence-based practice (EBP) guidelines (Parker, 2014). Clinical preceptorship combines education, simulation, and practice to refine critical thinking and clinical judgment skills in a non-threatening manner. This improves the bedside nurse’s ability to collaborate with the interdisciplinary team (Hart et al., 2015). Preceptors provide real-time coaching and feedback necessary to hone and deepen nurse competencies, skills, and communication efforts. Tools and assessment systems are enhanced when nurses develop and employ analytical decision-making strategies. Training and maintaining competencies to manage patient deterioration yields improved patient care. Visual tools and assessment systems assist bedside nurses in rapid assessment of patient condition and increase their focus on subtle patient changes (Garvey, 2015). Tools and assessment systems are enhanced when nurses develop and employ analytical decision-making strategies. Rapid responses and interventions necessitate that bedside nurses demonstrate competencies and skills synergistic with a patient’s condition. Synergy requires nurse engagement and empowerment to fully complement the patient’s condition. Nurses must be empowered to apply critical thinking and clinical judgment to patients with the focus on reducing patient harm and improving patient outcomes (Astroth et al., 2017; Wakeam et al., 2014). Collaborative Teamwork Organizational commitment to the RRT encourages multidisciplinary approaches to response efforts and provides the necessary foundation for continued improvements... Critical care guidelines and best practices inform development of education activities and simulation training. These activities should include all members of the interdisciplinary team to promote cohesion, communication, and collaborative practice (Speck et al., 2012). Organizational commitment to the RRT encourages multidisciplinary approaches to response efforts and provides the necessary foundation for continued improvements in skill-building and education among hospital staff (Avis, Grant, Reilly, & Foy, 2016). A dedicated interdisciplinary RRT reduces barriers to bedside nurse activation by formalizing and standardizing processes for patient surveillance (Mailey et al., 2006; Wakeam et al., 2014). This dedicated resource improves patient care by reducing unfounded alert and response calls and improves nurse satisfaction by building rapport and collaboration among hospital staff (Angel et al., 2016; Avis et al., 2016; Leach & Mayo, 2013; Mailey et al., 2006). Role consistency empowers bedside nurses to develop improved communication skills and builds personal confidence in their assessment skills through feedback and coaching opportunities with the RRT. During RRT activation, dedicated intensivists and pharmacists, respectively, support bedside nurses through efficient practices and effective interdisciplinary care, which leads to improved patient safety (Feih, Peppard, & Katz, 2017; Jung et al., 2016). An example of supportive practice is to exercise a “post-code pause;” this activity provides a time for those involved in a RRT, including the bedside nurse, to acknowledge and validate concerns or feelings related to the emergency event (Copeland & Liska, 2016, p. 59). Standardizing a process for the post-code pause highlights the importance it has for staff cohesiveness and promotes organizational safety culture. Standardizing a process for the post-code pause highlights the importance it has for staff cohesiveness and promotes organizational safety culture. Additionally, as an expected action following an event, bedside nurses feel less threatened or intimated by the interdisciplinary team and experience validation of skills and competencies, thus improving collaborative relationships and combating self-doubt (Copeland & Liska, 2016). Efforts to augment bedside nurse competencies create an enhanced synergistic relationship to patient condition. Synergistic teams, such as those using the TeamSTEPPS® system, optimize patient outcomes through an evidence-based model focused on high-quality, effective teamwork principles and execution (AHRQ, 2017a, n.p.). As an organizational initiative, patient safety is elevated through collaborative relationships and sustainable processes for effective team responses to a patient’s medical emergency. Organizational Culture Increasing the organizational awareness of the RRT process...increases the nurse activation and responsiveness rates of RRT Increasing the organizational awareness of the RRT process, specifically the benefits to the bedside nurse and the goals of improved patient safety, increases the nurse activation and responsiveness rates of RRT (Astroth et al., 2017). An organizational culture that supports the initiation of RRT, coupled with the increased awareness, complements nurse confidence in skills and clinical judgment, creating synergy between the patient’s needs and the nurse’s competencies. Conclusion“Failure to rescue occurs when healthcare providers do not recognize signs and symptoms and subsequently fail to take appropriate action to stabilize the patients” (Garvey, 2015, p. 145). In response to the IHI 2005, “Saving 100,000 Lives” campaign, healthcare organizations formed rapid response teams (RRT) to mitigate poor patient outcomes by bringing intensive care interventions to the medical-surgical patient (Walston et al., 2016). Timely recognition and activation of rapid response mechanisms requires prudent nursing care, evidenced by synergy between patient needs and nurse competencies (Hardin & Hussey, 2003). Left unbalanced, patient outcomes decline and nurse confidence diminishes. Bedside nurses influence timely responses and life-saving interventions in the patient whose condition rapidly deteriorates. Bedside nurses influence timely responses and life-saving interventions in the patient whose condition rapidly deteriorates. As discussed, synergistic imbalance is affected by several barriers. Improving recognition of early warning signs and improved clinical assessment allow for timely intervention. Tools and standardized criteria remove speculation about patient condition and support the expansion of bedside nurse clinical judgment (Dobuzinsky, 2017). Effective activation of the response team from novice, advanced beginner and competent nurses necessitates ongoing coaching, evaluation and feedback, as well as concurrent simulation activities to foster critical thinking skills. A highly functional RRT can improve patient outcomes if the clinical deterioration is arrested through rapid assessment and intervention from the bedside nurse (Angel et al., 2016). Continuous quality improvement initiatives must focus on maintaining and growing bedside nurse competencies to decrease mortality rates and reduce healthcare costs (Stolldorf, 2008). In essence, achievement of synergy between patient condition and bedside nurse competencies is met through a supportive, collaborative organization focused on a culture of safety, dynamic interdisciplinary relationships, and high-quality educational efforts. Collectively, these components remove barriers that impede the nurse’s recognition and activation of a rapid response team for a deteriorating patient. AuthorWendy R. Clayton, MSN, RN, CCM, CPHQ Wendy Clayton is the Clinical Program Coordinator at Penn State Health St. Joseph. In her role, Wendy enculturates evidence-based practices for disease management using collaborative interdisciplinary strategies, quality improvement initiatives, and performance analytics. She aims to improve patient outcomes and organizational quality across the care continuum. ReferencesAgency for Healthcare Research and Quality (AHRQ). (2017a). About TeamSTEPPS®. Retrieved from https://www.ahrq.gov/teamstepps/about-teamstepps/index.html Agency for Healthcare Research and Quality (AHRQ). (2017b). Health care simulation to advance safety. Retrieved from https://www.ahrq.gov/research/findings/factsheets/errors-safety/simulproj15/index.html Alsherhri, B., Klarare Ljungberg, A., & Ruter, A. (2015). Medical-surgical nurses' experiences of calling a rapid response team in a hospital setting: A literature review. Middle East Journal of Nursing, 9(3), 3-23. doi: 10.5742/MEJN.2015.92660 American Association of Critical-Care Nurses (AACN). (2017). The AACN synergy model for patient care. Retrieved from https://www.aacn.org/nursing-excellence/aacn-standards/synergy-model Angel, M., Ghneim, M., Song, J., Brocker, J., Tipton, P. H., & Davis, M. (2016). The effects of a rapid response team on decreasing cardiac arrest rates and improving outcomes for cardiac arrests outside critical care areas. MedSurg Nursing, 25(3), 153-158. Astroth, K. S., Woith, W. M., Jenkins, S. H., & Hesson-McInnis, M. S. (2017). The measure of facilitators and barriers to rapid response team activation. Applied Nursing Research, 33, 175-179. doi: 10.1016/j.apnr.2016.12.003 Avis, E., Grant, L., Reilly, E., & Foy, M. (2016). Rapid response teams decreasing intubation and code blue rates outside the intensive care unit. Critical Care Nurse, 36(1), 86-90. doi: 10.4037/ccn2016288 Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative ed.). Upper Saddle River, NJ: Prentice Hall Health. Chan, P. S., Khalid, A., Longmore, L. S., Berg, R. A., Kosiborod, M., & Spertus, J. A. (2008). Hospital-wide code rates and mortality before and after implementation of a rapid response team. Journal of the American Medical Association, 300(21), 2506-2513. doi: 10.1001/jama.2008.715 Copeland, D., & Liska, H. (2016). Implementation of a post-code pause. Journal of Trauma Nursing, 23(2), 58-64. doi: 10.1097/JTN.0000000000000187 Dobuzinsky, A. M. (2017). The role of the bedside nurse during a rapid response call. Med-Surg Matters, March-April, 4-6. 201708131511211239555836 Fasolino, T., & Verdin, T. (2015). Nursing surveillance and physiological signs of deterioration. MedSurg Nursing, 24(6), 397-402. Feih, J., Peppard, W. J., & Katz, M. (2017). Pharmacist involvement on a rapid response team. American Journal of Health-System Pharmacy, 74(5S1), S10-S16. doi: 10.2146/ajhp160076 Garvey, P. K. (2015). Failure to rescue: the nurse's impact. MedSurg Nursing, 24(3), 145-149. Hardin, S., & Hussey, L. (2003). AACN synergy model for patient care: Case study of a CHF patient. Critical Care Nurse, 23(1), 73-76. Hart, P. L., Brannan, J. D., Long, J. M., Brooks, B. K., Maguire, M. R., Robley, L. R., & Kill, S. R. (2015). Using combined teaching modalities to enhance nursing students' recognition and response to clinical deterioration. Nursing Education Perspectives, 36(3), 194-196. doi: 10.5480/13-1083.1 Institute of Healthcare Improvement (IHI) (2017a, May 8). Early warning systems: Scorecards that save lives. Retrieved from http://www.ihi.org/resources/pages/improvementstories/earlywarningsystemsscorecardsthatsavelives.aspx Institute of Healthcare Improvement (IHI) (2017b, May 8). Rapid response teams. Retrieved from http://www.ihi.org/Topics/RapidResponseTeams/Pages/default.aspx Jung, B., Daurat, A., DeJong, A., Chanques, G., Mahul, M., & Monnin, M., ... Jaber, S. (2016). Rapid response team and hospital mortality in hospitalized patients. Intensive Care Medicine, 42(4), 494-504. doi: 10.1007/s00134-016-4254-2 Lavoie, P., Pepin, J., & Cossette, S. (2015). Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nursing Education in Practice, 15(3), 181-191. doi: 10.1016/j.nepr.2015.01.006 Leach, L. S., & Mayo, A. M. (2013). Rapid response teams: Qualitative analysis of their effectiveness. American Journal of Critical Care, 22(3), 198-209. doi: 10.4037/ajcc2013990 Mailey, J., Digiovine, B., Baillod, D., Gnam, G., Jordan, J., & Rubinfeld, I. (2006). Reducing hospital standardized mortality rate with early interventions. Journal of Trauma Nursing, 13(4), 178-182. Manu, P., Loewenstein, K., Girshman, Y. J., Bhatia, P., Barnes, M., & Whelan, J.,...McManus, M. (2015). Medical rapid response in psychiatry: Reasons for activation and immediate outcome. Psychiatry Quarterly, 86(4), 625-632. doi: 10.1007/s11126-015-9356-4 Michael, R., Areti, S., Nektaria, K., Michael, S., Despoina, S., Manolis, L., & Nikolaos, R. (2015). Evaluation of intuition levels in nursing staff. Health Science Journal, 9(3:4). Moriarty, J. P., Schiebel, N. E., Johnson, M. G., Jensen, J. B., Caples, S. M., & Morlan, B. W.,...Naessens, J. M. (2014). Evaluating implementation of a rapid response team: Considering alternative outcome measures. International Journal of Quality in Health Care, 26(1), 49-57. doi: 10.1093/intqhc/mzt091 Mullany, D. V., Ziegenfuss, M., Goleby, M. A., & Ward, H. E. (2016). Improved hospital mortality with a low MET dose: the importance of a modified early warning score and communication tool. Anaesthesia & Intensive Care, 44(6), 734-741. doi: 10.1177/0310057X1604400616 Parker, C. G. (2014). Decision-making models used by medical-surgical nurses to activate rapid response teams. MedSurg Nursing, 23(3), 159-164. Patient Safety & Healthcare Quality (2005). IHI launches national campaign to save 100,000 lives in U.S. hospitals. Retrieved from https://www.psqh.com/janfeb05/100K.html Petiprin, A. (2016). AACN synergy model. Retrieved from http://www.nursing-theory.org/articles/AACN-synergy-model.php Roberts, K. E., Bonafide, C. P., Weirich Paine, C., Paciotti, B., Tibbetts, K. M., Keren, R.,...Holmes, J. H. (2014). Barriers to calling for urgent assistance despite a comprehensive pediatric rapid response system. American Journal of Critical Care, 23(3), 223-229. doi: 10.4037/ajcc2014594 Speck, R. M., Jones, G., Barg, F. K., & McCunn, M. (2012). Team composition and perceived roles of team members in the trauma bay. Journal of Trauma Nursing, 19(3), 133-138. doi: 10.1097/JTN.0b013e318261d273 Stolldorf, D. (2008). Rapid response teams: Policy implications and recommendations for future research. Journal of Nursing Law, 12(3), 115-122. doi:10.1891/1073-7472.12.3.115 Subbe, C. P., & Welch, J. R. (2013). Failure to rescue: Using rapid response systems to improve care of the deteriorating patient in hospital. Clinical Risk, 19(1), 6-11. doi.org/10.1177/1356262213486451 Tait, D. (2010). Nursing recognition and response to signs of clinical deterioration. Nursing Management, 17(6), 31-35. doi: 10.7748/nm2010.10.17.6.31.c8007 Wakeam, E., Hyder, J. A., Ashley, S. W., & Weissman, J. S. (2014). Barriers and strategies for effective patient rescue: A qualitative study of outliers. The Joint Commission Journal on Quality and Patient Safety, 40(11), 503-513. Waldie, J., Tee, S., & Day, T. (2016). Reducing avoidable deaths from failure to rescue: A discussion paper. British Journal of Nursing, 25(16), 895-900. doi: 10.12968/bjon.2016.25.16.895 Walston, J. M., Cabrera, D., Bellew, S. D., Olive, M. N., Lohse, C. M., & Bellolio, M. F. (2016). Vital signs predict rapid-response team activation within twelve hours of emergency department admission. Western Journal of Emergency Medicine, 17(3), 324-330. doi: 10.5811/westjem.2016.2.28501 White, K., Scott, I. A., Vaux, A., & Sullivan, C. M. (2015). Rapid response teams in adult hospitals: Time for another look? Internal Medicine Journal, 1211-1220. doi:10.111/imj.12845 Table 1. Patient Characteristics Guiding Patient Care
(AACN, 2017; Hardin & Hussey, 2003) July 19, 2019 DOI: 10.3912/OJIN.Vol24No03PPT22 https://doi.org/10.3912/OJIN.Vol24No03PPT22 Citation: Clayton, W.R., (July 19, 2019) "Overcoming Barriers Impeding Nurse Activation of Rapid Response Teams" OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 3. Related Articles
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