Nurses' perception of the quality of the Rapid Response Team

verify the perception nurses have of the quality of the Rapid Response Team in the structure, process and outcome dimensions, as well as the influence of time of practice in the institution and the work shift of the professionals on this perception.

Method:

cross-sectional study, conducted between September and October 2016, with questionnaires to 55 nurses working in inpatient care units or members of the Rapid Response Team. The positive index and inferential tests were used in the data analysis.

Results:

a satisfactory positive index was identified in 25 of the 37 items analyzed, and the main frailties occurred in the process dimension. There was discrepancy in the perception of professionals with different length of time in the institution about medical consumables (p=0.05) and request for the Rapid Response Team (p=0.03), besides the work shift and communication among the members involved (p=0.02).

Conclusion:

the nurses' perception of the quality of the Rapid Response Team is satisfactory, especially in the areas of structure and outcome.

Descriptors:
Rapid Response Team of Hospitals; Quality Management; Nursing; Inpatient Care Units; Cardiology

Process Dimension	Positive Index (%)
P1. The decision to request RRT depends exclusively on the signs of clinical deterioration established in codes blue and yellow.	84.3
P2. RRT must also be requested when the nurse of the unit is concerned about any change in the patient's condition, regardless of the stability of vital signs.	42.0
P3. The RRT team, when requested, appears in 3 minutes to start the care for the patient in a code blue.	71.7
P4. The RRT team, when requested, appears in 4 minutes to start the care for the patient in a code yellow.	82.3
P5. During a code blue or yellow in the unit, it is easy to request/locate RRT at the institution.	93.9
P6. RRT carries out visits in the morning and afternoon to patients in restrained demand.	5.0
P7. RRT participates in the establishment of the treatment plan of critically ill patients in the unit.	5.5
P8. RRT discusses daily the assistance plan with the professionals (nurses, emergency physician, resident physician) involved in the care for patients in restrained demand or in codes blue and yellow.	7.7
P9. The nurse knows the clinical conditions of all patients treated by RRT on the unit under her/his supervision, as well as the behavior and prescribed treatments.	68.2
P10. RRT develops educational activities, qualifying new RRT for the treatment of critically ill patients in the units.	53.8
P11. RRT develops educational activities for the nursing staff in the units of practice	53.2
P12. Data from the services performed by RRT are used as indicators of quality and/or safety in units	83.3
P13. RRT has a research/study group formed by the RRT staff and by professionals of the units.	72.5
P14. It is essential to monitor critically ill patients in restrained demand, due to the difficulty of immediate transfer to the Intensive Care Unit.	86.7
P15. Effective communication occurs between the doctor of TRR and the clinic doctor in appointments suggested to patients.	68.2
P16. RRT communicates with the nurse when visiting patients in the care units.	40.5
P17. Communication between members of RRT and the nurse of the unit is effective, clear and objective.	89.4
P18. RRT professionals are accessible for the codes yellow and blue and or restrained demand.	90.0
P19. The nurse of the unit follows the code blue during the whole service, along with the RRT professionals.	98.1
P20. The nurse of the unit follows the code yellow during the whole service, along with the RRT professionals.	100.0

Structure Dimension	Positive Index (%)
E1. The nurse is the one responsible for requesting RRT, because he/she is 24 hours beside the patient	84.9
E2. Permanent materials (non-invasive blood pressure monitor, cardioscope, pulse oximeter, defibrillator, mechanical fan, secretion aspirator, glucose meter, infusion pump, gas network, among others) are sufficient and available when requested by RRT	76.9
E3. Medical consumables (infusion equipment, needled devices, medications, materials for intubation, among others) are available in sufficient quantities to treat the patients assisted by RRT.	92.6
E4. Patients treated by RRT in the unit have the resources in the nursing staff qualified and in sufficient number to provide the necessary care.	71.1
E5. The emergency car of the unit has the necessary materials and equipment, in accordance with the protocol adopted in the institution, for the care of patients by RRT.	98.2
E6. The manual/protocol of routines about RRT is available and has easy access to the unit.	96.1
E7. The physical structure of the unit provides a safe and effective care (without ramp, wide doors, adequate space between beds, lighting, electrical network, gas network, monitor countertop/infusion pump) to patients.	43.6
E8. There is a unique location for RRT technical or research meetings.	80.0
E9. There is an exclusive nurse in the institution to work with RRT.	64.7

Outcome Dimension	PI (%)
R1 With the assistance of the doctor and of RRT provided concurrently, I have greater security in the implementation of the nursing care provided in the unit under my supervision.	100.0
R2. As a nurse I am not afraid to take criticism from the institution or from the coordinator of RRT, for requiring the service staff, when patients do not meet the criteria established by the protocol.	72.7
R3. The differential service proposed by RRT to the patient in restrained demand and/or monitored for 72 hours after discharge from the Intensive Care Unit improves the assistance provided to patients.	79.3
R4. It is essential to implement RRT at night in the institution	93.7
R5. RRT reduces the risk of clinical deterioration of patients in the units.	92.4
R6. RRT reduces the mortality rate of patients in codes blue and yellow or restrained demand.	96.3
R7. RRT and the nursing staff of the unit under my supervision have a good interpersonal relationship.	91.7
R8. Every month the institution or the coordinator of RRT provide the outcomes of the services performed in the units.	40.5

Variables	Categories	Time of practice in the institution Mean (Standard Deviation)	p value^* * Student's t-test.
E3.	Yes	15.3 (9.6)	0.05
E3.	No	5.7 (1.7)	0.05
P1.	Yes	16.1 (9.1)	0.03
P1.	No	8.4 (9.1)	0.03

Variables	Categories	Work shift		p value^* * Fisher's Exact Test.
Variables	Categories	Daytime n (%)	Nighttime n (%)	p value^* * Fisher's Exact Test.
P17.	Yes	33 (97.1)	9 (69.2)	0.02
P17.	No	1 (2.9)	4 (30.8)	0.02

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[1] Corresponding Author: Ágatha Stahl de Queiroz E-mail: agatha.queiroz@usp.br