title: The role of the primary care team in the rapid response system.
abstract: OBJECTIVE
  The purpose of the study is to evaluate the impact of primary service involvement on rapid response team (RRT) evaluations.
  
  
  METHODS
  The study is a combination of retrospective chart review and prospective survey-based evaluation. Data included when and where the activations occurred and the patient's code status, primary service, and ultimate disposition. These data were correlated with survey data from each event. A prospective survey evaluated the primary team's involvement in decision making and the overall subjective quality of the interaction with primary service through a visual analog scale.
  
  
  RESULTS
  We analyzed 4408 RRTs retrospectively and an additional 135 prospectively. The primary team's involvement by telephone or in person was associated with significantly more transfers to higher care levels in retrospective (P < .01) and prospective data sets. Code status was addressed more frequently in primary team involvement, with more frequent changes seen in the retrospective analysis (P = .01). Subjective ratings of communication by the RRT leader were significantly higher when the primary service was involved (P < .001).
  
  
  CONCLUSIONS
  Active primary team involvement influences RRT activation processes of care. The RRT role should be an adjunct to, but not a substitute for, an engaged and present primary care team.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: John C
authors.initials: JC
authors.lastname: O'Horo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Ronaldo A
authors.initials: RA
authors.lastname: Sevilla Berrios
authors.affiliation: Department of Nursing, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Elmer
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Venu
authors.initials: V
authors.lastname: Velagapudi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Caples
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: jensen.jeffrey@mayo.edu.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Jensen
mesh_terms: D000368:Aged; D003142:Communication; D003657:Decision Making; D005260:Female; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D011320:Primary Health Care; D017064:Process Assessment, Health Care
keywords: Communication; Critical care; Guideline adherence; Hospital rapid response team; Patient care team; Quality of health care