The impact of a nurse practitioner rapid response team on systemic inflammatory response syndrome outcomes.
BACKGROUND
Early recognition of systemic inflammatory response syndrome (SIRS) can significantly alter outcomes such as mortality, unplanned intensive care unit admissions, and cost.


OBJECTIVE
Through utilization of a nurse practitioner rapid response team (NP-RRT) and a revised database query, earlier identification of SIRS patients and consistent implementation of early goal-directed therapy (EGDT) on the medical-surgical units would positively impact SIRS outcomes.


METHODS
A database query that indicated when patients had 2 or more of the SIRS criteria and anion gap acidosis was initiated. The NP-RRT reviewed the triggered patients, and if blood cultures, lactic acid levels, volume resuscitation, or antibiotics were not in place, they were either ordered or recommended to the physicians.


RESULTS
All 4 components of EGDT were more frequently discussed with physicians at a statistically significant level. Individual components of EGDT had high levels of implementation. Unplanned intensive care unit admissions were reduced by 3.25% after intervention with a cost savings of approximately $250 000. After initiation of the database query, patients seen by the NP-RRT were more acutely ill, with a statistically higher mean anion gap acidosis, and as a result, mortality was essentially unchanged.


CONCLUSIONS
Improved detection of SIRS and successful implementation of EGDT led to a bridging of the evidence-to-practice gap. Future recommendations on earlier detection of lactic acidosis were rendered as a consequence of this study. The NP-RRT will continue to use the database query to identify SIRS patients in a timely manner and expedite EGDT.
Linda Benson, DNP, RN, ACNP-BC, CCRN, is a member of the nurse practitioner rapid response team at Bronson Methodist Hospital in Kalamazoo, Michigan. Research interests include bridging evidence to practice for vulnerable populations and outcomes management research. Susan Hasenau, PhD, RN, NNP, CTN-A, is a nursing faculty member at Madonna University in Livonia, Michigan, with practice areas of cultural competency and pain management. Nancy O'Connor, PhD, RN, ANP-BC, is the chair of the Nursing Graduate Program and DNP Program Director at Madonna University in Livonia, Michigan. Her practice areas include primary care adult health NP issues, health promotion, self-care motivation and advanced nursing practice. Diane Burgermeister, PhD, RN, PMHCNS-BC, is a nursing faculty member at Madonna University in Livonia, Michigan, with practice areas of evidence-based practice and mental health screening and services.
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D016022:Case-Control Studies; D020000:Decision Support Systems, Clinical; D042241:Early Diagnosis; D005260:Female; D057209:Hospital Rapid Response Team; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D009722:Nurse Practitioners; D010343:Patient Admission / Q000706:statistics & numerical data; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis