Dealing with the impact of the COVID-19 pandemic on a Rapid Response Team operation in Brazil: Quality in practice

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

QUALITY PROBLEM OR ISSUE: Up to July 13, 2020, more than 12 million laboratory-confirmed cases of 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 COVID19 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 ICU 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 2 to 4 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 two-fold in relation to the pre-pandemic 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.