Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice. (30th September 2020)

• Record Type: Journal Article
• Authors: Rocha, Hermano Alexandre Lima; Alcântara, Antonia Célia de Castro; Netto, Fernanda Colares de Borba; Ibiapina, Flavio Lucio Pontes; Lopes, Livia Amaral; Rocha, Sabrina Gabriele Maia Oliveira; Leite, Elias Bezerra
• Is Part Of: International journal for quality in health care. Volume 33:Number 1(2021)
• Publication Date: 2020-09-30
• Subjects: COVID-19 -- hospital rapid response team -- critical care -- critical care outcomes -- mortality -- workforce; Medical care -- Quality control -- Periodicals; 362.1068
• DOI: 10.1093/intqhc/mzaa114
• Languages: English
• ISSNs: 1353-4505

Abstract

Abstract: Quality problem or issue: Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). Initial assessment: An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. Choice of solution: Adequacy of workforce sizing. Implementation: The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. Evaluation: After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. Lessons learned: The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.