Critical Care Response Team  

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The Service:

CCRT is a quality initiative for the National Guard health Affairs and facilitated by the adult Intensive Care Unit, King Abdulaziz City-Riyadh launched in November 2007. The goal of the team is to provide clinical support and facilitate intervention in order to enhance patient’s outcome. CCRT is focused on coordinating and promoting an appropriate level of care for the patient at the right time by:

Objectives:

  • Facilitate early intervention and stabilization to prevent clinical deterioration of any adult in-patient prior to cardiopulmonary arrest or other potentially life threatening event.
  • Decrease the number of cardiopulmonary arrest that occurs outside the ICU.
  • To facilitate timely and appropriate ICU admissions.
  • Participate in end-of-life discussions and decision-making with primary health care providers, patients and /or family members.
  • Provide 48-hour follow-up to patients discharged from the ICU: aimed at supplementing care and avoiding ICU re-admissions.
  • For continual support and education for all level of staff.
  • Encourage continued call to CCRT by responding promptly and using every patient encounter as an opportunity to facilitate shared learning as well as promoting an improved culture of care.

Scope of Service:

CCRT provide services to all surgical, medical oncology, hepatobiliary, obstetric and gynecology adult inpatient 24 hours a day, 7 days a week. The team consist of an intensivist, a staff physician a critical care nurse and the respiratory therapist during the day. After hours, the team is staffed by a staff physician, a critical care nurse and the respiratory therapist while the intensivist will be consulted whenever necessary.

Calling Criteria:

Initiation of the CCRT is at the discretion of the bedside health care provider(s) and activation does not require a prior order or an explanation progress note. CCRT is activated when a patient meets any ONE or more of the following criteria:

  • Heart rate equal or less than 40 beat per minute or equal or more than 130 beat per minute.

  • Systolic blood pressure equal or less than 90 mmHg or equal or more than 200 mmHg.

  • Airway – Threatened or Stridor or Excessive Secretions or Distressed Breathing.

  • Respiratory rate equal or less than 8 breaths per minute or equal or more than 30 breaths per minute.

  • Saturation equal or less than 90 % or equal on more 50% or 6L/min of oxygen.

  • Glasgow coma scale decrease by 2 or more points over 24 hrs.

  • Urine output equal or less than 100 ml over 4 hours for patient with foley.

  • Staff member is worried about the patient.

Current and Future:

On the average, there are 77 CCRT activations monthly and majority of the health care providers who activate the team are the nurses in the ward. The CCRT response time is between 0 to 5 minutes. Majority of the CCRT calls are respiratory, hemodynamic compromise and the reduction of the conscious level of the patient. Since CCRT has been launched, there is a 50 to 60 % reduction in the number of cardio respiratory arrest in all the wards covered the CCRT services.

CCRT will continue to expand its services in the near future to accommodate the expansion of the organizational facility. The team will continue to give their best service and support to the health care givers and all adult inpatients of non-critical care areas to meet the Institute for Healthcare Improvement campaign to save 5 million lives.

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