Swift interventions: How SNUBH’s rapid response team enhances patient safety

Since the early 2010s, Seoul National University Bundang Hospital (SNUBH) has been operating a rapid response team (RRT) to address the worsening conditions of inpatients and handle emergency situations within the hospital.

Led by Professor Lee Yeon-joo from the Department of Pulmonary Medicine, the RRT stands ready to respond at a moment’s notice, safeguarding patient safety at the forefront.

A crucial system for patient safety

"Studies show that 40-60 percent of inpatients exhibit signs of deterioration six to eight hours before cardiac arrest," Professor Lee said. "If medical staff fail to recognize these signs or provide appropriate treatment, the patient may suffer cardiac arrest."

According to Lee, the traditional medical system often delays critical care, as junior or less experienced doctors are usually the first responders in large hospitals. Such a multi-step process to report to a specialist can lead to missed golden opportunities to save lives.

As rapid intervention by experienced medical personnel can prevent a patient from deteriorating to the point of cardiac arrest, the hospital quickly established the RRT, known as SAFER (SNUBH medical Alert First Responder) in 2012.

"In the U.S., the RRT system was established as a standard guideline in the field of patient safety in 2008, and it is already being implemented in many hospitals,” Professor Lee said. “Our hospital was the third in Korea to introduce an RRT.”

Lee stressed that the impact of the RRT has been significant with the overall incidence of cardiac arrests in the hospital wards dropping from 60 cases per 1,000 admissions before introducing RTT to just 1.23 cases in a mere three years.

Also, during that timeframe, the number of cardiac arrests during the RRT’s active hours further decreased from 0.82 to 0.49 per 1,000 admissions, showcasing the team's vital role in improving patient outcomes.

Swift response in emergencies

The RRT currently comprises five dedicated nurses and 13-15 on-call professors, all volunteering their expertise. Many of these professors have been with the team since its inception, and the nurses are seasoned veterans from intensive care units (ICUs).

The team uses the hospital-developed "Best Board" system to monitor high-risk patients' vital signs in real-time, allowing them to identify and respond to potential emergencies promptly.

"When an urgent call comes from an RRT nurse, we rush to the scene immediately, trusting in our nurses’ exceptional skills," Professor Lee said. "Our teamwork is unparalleled, and it’s essential in our line of work where every second counts."

In 2023 alone, the Best Board system screened patients’ vital signs an average of 21,290 times per month. In 293 of these cases, the RRT nurses and doctors provided timely interventions that could have otherwise been delayed under the old system.

When responding to emergencies, the RRT brings along essential equipment like portable blood analyzers, video laryngoscopes for intubation, and portable ventilators, earning them the nickname "the mobile ICU."

This equipment ensures that critical care can begin immediately upon their arrival.

The RRT also supports the safe transfer of severely ill patients within the hospital, such as those requiring ventilator support or blood pressure medication, ensuring stability and continuous monitoring during procedures.

The need for building a national database

The RRT at SNUBH is committed to continuous improvement.

The team conducts monthly meetings to analyze critical cases and outcomes, driving various voluntary improvement activities. One significant advancement was refining the Best Board system to reduce false alarms caused by data entry errors, ensuring more accurate monitoring.

As AI technology becomes more prevalent, the RRT plans to integrate AI algorithms to enhance early detection of high-risk patients.

Lee, who is also a long-time advisor and committee member on national rapid response system projects, emphasized the need for a comprehensive national database.

"In 2017, only about 13 hospitals in Korea had RRTs,” Lee said. “However, by 2019, this number grew to 30, and today, nearly 50 institutions have implemented such teams.”

As a result, there is a need to compile and manage this growing body of data to establish a representative database and develop standard guidelines tailored to Korea’s needs, she added.