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Background Multidisciplinary rapid response teams focus on patients' emergent needs and manage critical situations to prevent avoidable deaths. Although research has focused primarily on outcomes, studies of the actual team effectiveness within the teams from multiple perspectives have been limited. Objective To describe effectiveness of rapid response teams in a large teaching hospital in California that had been using such teams for 5 years. Methods The grounded-theory method was used to discover if substantive theory might emerge from interview and/or observational data. Purposeful sampling was used to conduct in-person semistructured interviews with 17 key informants. Convenience sampling was used for the 9 observed events that involved a rapid response team. Analysis involved use of a concept or indicator model to generate empirical results from the data. Data were coded, compared, and contrasted, and, when appropriate, relationships between concepts were formed. Results Dimensions of effective team performance included the concepts of organizational culture, team structure, expertise, communication, and teamwork. Conclusions Professionals involved reported that rapid response teams functioned well in managing patients at risk or in crisis; however, unique challenges were identified. Teams were loosely coupled because of the inconsistency of team members from day to day. Team members had little opportunity to develop relationships or team skills. The need for team training may be greater than that among teams that work together regularly under less time pressure to perform. Communication between team members and managing a crisis were critical aspects of an effective response team. [ABSTRACT FROM AUTHOR]

Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance. [ABSTRACT FROM AUTHOR]

Background: Teamwork is essential to safety. Few studies focus on teamwork between nurses and physicians in emergency departments (EDs)., Objective: The aim of this study was to examine differences between staff in the interventional group EDs (IGEDs) and control group EDs (CGEDs) on perception of job environment, autonomy, and control over practice., Methodology: This was a comparative cross-sectional study of the impact of teamwork on perceptions of job environment, autonomy, and control over practice by registered nurses and physicians (MDs) in EDs., Results: Staff in the IGEDs showed significant differences compared with staff who worked in the CGEDs on staff perception of job environment, autonomy, and control over practice., Conclusion: Active teamwork practice was associated with increased perceptions of a positive job environment, autonomy, and control over practice of both nurses and physicians.

Preventable deaths occur when signs and symptoms of risk and decline are not detected yet are present many hours prior to a deteriorating course. Rapid responses teams (RRTs), also referred to as medical emergency teams (METs) were introduced to improve patient safety by preventing code arrests and death. This research using a case study methodology describes a nurse-led RRT, developed at a large, safety net, teaching hospital in California. Safety-net hospitals are challenged to deliver care and meet the complex needs of vulnerable patient populations. This hospital is a mission driven organization that is focused on the patient and the needs of underserved populations. To respond to the call for reform for patient safety and reduce adverse events, the organization adopted RRTs, early recognition rounds by RRT registered nurses (RNs) and the use of trigger alerts by nursing assistants (NAs) to expand the surveillance and identification of patients most at risk of clinical deterioration. Collaboration with interns and residents (house staff) facilitated their involvement and response to RRT calls. Using quality data from 2005 to 2010, findings from this patient safety innovation address RRT utilization, frequency of non-ICU code arrests, hospital mortality, and post-arrest survival outcomes., (© 2012 National Association for Healthcare Quality.)

Background: Patients are admitted to hospitals everyday with clinical conditions that can change dynamically resulting in adverse outcomes. The rapid response team (RRT) intervention is a formalised resource to respond to the nurse's concerns about such patients before code arrest occurs. Registered nurses (RNs) are in a position to recognise critical changes and to rescue patients at the most opportune moments, but little is known about how RNs rescue patients using these increasingly popular teams. Our aims were to investigate how RNs rescue patients in hospitals where RRTs are in place., Methods: Fifty participants involved with RRTs participated in semistructured individual interviews in six California hospitals. Data were analysed using coding and constant comparison methods., Results: Overall, RNs view RRTs as a helpful and effective safety intervention. RRT RNs and bedside RNs support one another in a synergistic way to prevent adverse patient events during the rescuing process. However, traditional hierarchies and relationships with physicians and supervisors impede some components of RN decision-making during rescuing., Conclusions: RNs find the RRT supportive when their patient is at risk or care needs are changing. They benefit from a formalised mechanism that enables immediate access to resources. RRT RNs in this study applied their expertise with critically ill patients to rescue medical and surgical patients. The RRT RN and bedside RNs' interaction influenced the rescuing process. Their role synergy was a value-added contribution to preventing adverse events and to improving patient safety by RNs.