ACLS, MET, RRT, CUE?
Alphabet soup? No.
You probably know ACLS – Advanced Cardiac Life Support.
You may have heard of MET – Medical Emergency Teams (also known as Rapid Response Teams or RRTs).
CUE may be new to you. It refers to “Hone CUE Recognition” – virtual simulation training modules you can download to your smartphone or tablet.
Why are these of interest to healthcare practitioners? All of them have the potential to help save patient lives.
RESPONSES TO IMPROVE PATIENT SAFETY
A 2016 Johns Hopkins study reported that the third most common cause of deaths in the US (after heart disease and cancer) is medical error. The most common type of medical error is error of diagnosis.
One way to improve patient safety is to train healthcare practitioners to deal with urgent medical risk through Advanced Cardiac Life Support (ACLS). Healthcare practitioners and others with this certification are specially trained in a set of clinical algorithms to recognize and urgently treat cardiac arrest, stroke, myocardial infarction, and other life-threatening cardiovascular emergencies.
An initiative of The Institute for Healthcare Improvement goes beyond ACLS. As part of a six-strategy plan to improve patient safety, one initiative was a Medical Emergency Team, also called a Rapid Response Team.
These teams usually consist of healthcare professionals who bring critical care knowledge to the patient’s bedside. Among other skills, they are expert at recognizing early warning signs that a life-threatening risk may be developing.
Medical Emergency Teams, or Rapid Response Teams, can play a vital role in reducing respiratory and/or cardiac arrests and improve patient outcomes.
WHY EARLY WARNING SIGNS MIGHT NOT BE RECOGNIZED
In some cases, a patient may develop cardiac or respiratory arrest without warning. However, in most cases of life-threatening conditions, there are early warning signs. As well, the patient’s condition may be gradually deteriorating which is in itself a warning.
Unfortunately, these early warning signs may not be recognized in time to prevent a life-threatening situation. Why is that?
One common reason is a failure of communication. This could be between the patient and staff, or between staff members. For example, a patient may not mention anything to a staff person, or may mention something but the staff person doesn’t see the possible significance of the cue.
As well, patient information that one staff person has may not be communicated to other staff members during shift changes or other times. Not having all the available information can prevent staff members from having a clear picture of what is going on with a patient.
Another reason why some conditions are not caught early is failure to recognize a change in status or a patient’s deteriorating condition. In other cases, symptoms are eventually recognized, but too late to prevent respiratory failure or cardiac arrest.
A third reason is that concerns identified by family members may not be reported to a staff person. Or, sometimes family members report their concerns but staff members don’t recognize cues that a patient’s condition is deteriorating.
Among incidents that drew the attention of The Institute for Healthcare Improvement were highly-publicized cases where family members’ reported concerns were not addressed and patients died. In some cases, staff members thought family members didn’t understand “normal” responses to the particular treatment, and staff didn’t recognize that something was not normal. In other cases, staff members didn’t recognize the seriousness of symptoms reported by family members.
Families of patients are not medical specialists and may not know the “normal” reactions to a medical procedure. However, families of patients often know what is “normal” for the patient. As well, unlike pressured healthcare practitioners, families are not trying to stay on top of what’s happening with multiple patients in different locations. Families are only concerned with the well-being of one patient and can notice changes that might be impossible for a staff person to see.
HOW MEDICAL EMERGENCY TEAMS (RAPID RESPONSE TEAMS) CAN HELP
Medical Emergency Teams, or Rapid Response Teams, are one of six initiatives created as part of the Institute for Healthcare Improvement’s “100,000 Lives Campaign.” The idea is that any health care worker can bypass the typical chain of command. Instead, staff can call a specialized team to assess a patient quickly and intervene immediately if necessary.
The key point is this. Unlike the traditional “code” team, the Rapid Response Team can intervene before the patient experiences respiratory or cardiac arrest.
That means am impending medical emergency may be prevented.
University of Pittsburgh Medical Centre Shadyside and Children’s Hospital has gone one step further. In addition to staff members, Shadyside has invited patients and families to call for a Rapid Response Team if they have unresolved concerns.
At the time of admission, patients and family members are invited to pick up any phone in the hospital to report a Condition H (for “help”). They can call if they:
Help is available 24/7. The phone call goes to the hospital operator, who pages the RRT. The team arrives at the patient’s bedside within minutes, listens to the patient’s or family member’s concerns, assesses the patient, and responds with medical care or further investigation as needed.
PATIENTS AND FAMILIES USED “CONDITION H” APPROPRIATELY
When the staff at Shadyside first introduced the idea of Condition H, many feared that too many calls would be made for non-urgent reasons, such as cold meals or uncomfortable pillows. However, the results of a pilot test were positive, and the intervention was spread throughout the hospital.
In the first nine months, Shadyside received 20 calls, mostly from patients. All calls were judged to have been appropriately initiated, and the hospital considers each call a learning experience. It is understood that even though something interfered with communication between the patient, family, and staff, individuals should not be blamed. “Condition H (for help)” is considered an opportunity to step in before a tragedy occurs.
Shadyside believes that the program has also caused staff members to ramp up their communication with patients. Patients say they feel much safer knowing they can get immediate attention if they feel they need it.
DO RAPID RESPONSE TEAMS MAKE A DIFFERENCE?
By identifying unstable patients who may be headed for respiratory failure, cardiac arrest, stroke or other serious situation, staff can intervene and prevent such an event. For example, before a cardiac arrest, patients often develop signs such as increased respiratory rate, anxiety and changes in mental status. Identifying a patient in the early stages of decline can prevent a situation from getting worse.
Members of a Rapid Response Team are trained and have the expertise to recognize early signs of many conditions, such as stroke, sepsis, myocardial infarction and impending respiratory failure. By identifying these conditions early, appropriate interventions and treatments can be done.
The Institute for Healthcare Improvement reports that Rapid Response Teams can decrease the number of cardiac arrests, deaths from cardiac arrests, number of days in the intensive care unit after cardiac arrest and number of in-patient deaths. Knowing the benefits of having a Rapid Response Team, it is not surprising that more healthcare facilities are using these teams.
IMAGINE WHAT COULD HAPPEN IF…
Okay, we know that lives have been saved because of Medical Emergency Teams or Rapid Response Teams in hospitals.
Not every hospital has a Medical Emergency Team. And not every healthcare practitioner practices within a hospital.
Imagine what could happen if healthcare practitioners, patients and family members in all hospitals had access to the expertise of a Medical Emergency Team?
Imagine what could happen if healthcare practitioners, patients or family members in rural or isolated areas had instant access to the expertise of a Medical Emergency Team?
Imagine what could happen if healthcare practitioners who work outside of hospital settings (home care, clinics, rehab facilities) had instant access to the expertise of a Medical Emergency Team?
Imagine what could happen if first responders whose first contact with patients is outside of any medical facility had instant access to the expertise of a Medical Emergency Team?
Imagine what could happen if every healthcare practitioner in any discipline was so well-trained that he or she could easily recognize when a patient’s cues indicate a potentially life threatening change?
HEALTHCARE PRACTITIONERS AND HONE CUE RECOGNITION
The beginning of this post mentioned Hone Cue Recognition – virtual simulation training modules you can download to your smartphone or tablet. The training modules are created by Hone Virtual Education.
The mission of Hone Virtual Education is to help you save lives. How? As the Hone website says…
“Our mission at Hone is to help practitioners perform at peak levels, capable of rapidly and correctly identifying diagnostic cues, enabling correct clinical decisions.”
“BE READY TO ACT. Prepare for what life really throws at you. Sharpen your cue recognition and learn by doing. Train with medically accurate patients on your smartphone or tablet. Feel prepared, effective, and ready to act at a moment’s notice.”
The purpose of Hone CUE Recognition training modules is the same as the purpose of Medical Emergency Teams: to help you save lives.
The logic is the same. Recognize warning signs. Act immediately. Reduce risk.
There’s one big difference: you don’t have to be in a hospital. You can use the modules – and more importantly, the skills they teach – any time in any setting.
FIND OUT MORE
At www.honevirtualeducation.com you can…
Learn more about Hone Cue Recognition virtual simulation training.
Be notified of updates and launch dates.
Apply to be a beta tester as new modules are developed for health practitioners in high pressure environments.
P.S. Improving healthcare practitioners’ recognition of early warning signs is one way to improve patient safety. If you’re interested in other patient safety issues, you might like to check out a Framework Institute paper by Marissa Ford et al.
Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design as well as extensive training and experience in adult learning and teaching. As an organizational and evaluation consultant, she’s worked with many healthcare and healthcare practitioner organizations. She’s bestselling author of Transitions: Pathways to the Life and World Your Soul Desires.
 ACLS Certification Institute (no date), “Medical Emergency Teams/Rapid Response Teams: Purpose and Benefits,” https://acls.com/free-resources/knowledge-base/bls-acls-surveys/medical-emergency-teams-rapid-response-teams-purpose-and-benefits
 Matthew Grissinge (2010), “Rapid Response Teams in Hospitals Increase Patient Safety,” Pharmacy & Therapeutics. 2010 Apr; 35(4): 191, 207, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873718/
 Mathew Grissinge (2010), op. cit.
 ACLS Certification Institute (no date), op. cit, cites Institute for Healthcare Improvement. “Establish a Rapid Response Team,” http://www.ihi.org/resources/Pages/Changes/EstablishaRapidResponseTeam.aspx
 Marissa Fond, Andrew Volmert, Kevin Levay, Emilie L’Hôte, Nat Kendall-Taylor, (2017), “Safety Is More than Caring: Mapping the Gaps between Expert, Public, and Health Care Professionals Understandings of Patient Safety,” Frameworks Institute, Washington DC, US. https://www.betsylehmancenterma.gov/assets/uploads/FW_MapTheGaps_Final.pdf
The Hone CUE Recognition App will soon be available on the App Store for early adopters. When it is available - you will be able to download it via the link below.