Meeting the medical needs of the sickest patients is very specialized work and caregivers need to respond quickly to their patients’ signs and symptoms. At York Central Hospital, in Richmond Hill Ontario, the new Critical Care Response Team (CCRT) responds quickly to the urgent needs of these patients.
York Central Hospital has one of 27 teams currently funded by the province. Among the team members are 18 specially trained ICU/CCRT nurses that work closely with the physicians and respiratory therapists. Trained at the Canadian Resuscitation Institute, CCRT nurses and physicians have advanced knowledge of how to triage patients who are at risk of further medical decline and identify what further intervention is required.
The goals of the CCRT are to: decrease cardiac/respiratory arrests, decrease ICU/hospital mortality, decrease inappropriate ICU admissions, decrease ICU readmissions, improve patient safety and above all, to be a resource to floor nurses.
According to the province’s Critical Care Information System, in Ontario, the average community hospital CCRT receives approximately 32 CCRT calls per 1,000 new patient admissions, while teaching hospitals average 44 calls per 1,000 new patients. At York Central Hospital the CCRT averages 64 calls per 1,000 new patient admissions. “The success of our team is clear in the positive feedback we have heard repeatedly from staff and physicians across the organization,” says Dr. Hy Dwosh, Medical Director, Critical Care and Lead for the CCRT. “This 24-hour resource is available 7 days per week, 365 days of the year for any hospital team member who has a concern about the condition of an adult in-patient.”
“Empowering nurses from across the organization to use their skills and intuition to get help for their patient as soon as possible, was one of our key goals for this exciting new initiative,” says Sean De Jardine, CCRT nurse and co-lead. “Every call is a valid one. Even if it turns out that a patient isn’t as ill as thought, we treat the call as an opportunity to educate the caller on what to look for or how to do something if the patient’s condition begins to deteriorate. We want to keep patients from having to go to the ICU, where possible and get them to the ICU as quickly as possible when they need to go. It’s a win-win for the patient, the unit staff and CCRT members.”
The majority of calls to the CCRT are from nurses; however the team also receives requests from doctors, respiratory therapists, pharmacists, dietitians as well as occupational and physiotherapists. Calls come in for all kinds of concerns including: threatened airways, difficulty breathing, poor blood pressure or heart rate, signs/symptoms of a stroke or prolonged seizures. “Upon receiving a call about a patient, we go and assess that patient and do whatever needs to be done to get the patient what they need,” adds De Jardine. “Sometimes they need the care of another team member, sometimes they just need some IV fluid or a new medication requiring a physician order, and sometimes they need to be transferred to the ICU. When the patient’s physician isn’t immediately available, we are.”
Hospital staff from across the hospital benefit because they receive immediate assistance for their sickest patients. Doctors appreciate the team because they are not always able to immediately respond at the bedside when new medical issues arise. With the CCRT they know that they have a highly trained team who can effectively assess a patient and tell them the important information they need to know about their patient’s condition.
“In my opinion, starting the CCRT was one of the best decisions York Central could have made for our patients,” says Telemetry Nurse Elilou Ranin. “I have seen the CCRT’s response make a real difference for our patients.”