A Code in the Waiting Room! Development of an Ambulatory Care-Based Emergency Response Team

Learning objective: Evaluate the development of an ambulatory-care based emergency response team (ERT).
Purpose: The purpose of this quality improvement project was to create an ERT within our clinic to provide the best response possible to our patients during emergency situations.
Background: A code in the lobby, hemorrhaging in a hallway, a myocardial infarction in the parking garage, an unconscious employee at his desk, and another diaphoretic, hypotensive employee slumped over in a locked bathroom. This large Magnet-designated medical specialties clinic experienced all these medical emergencies between 2021-2022. However, because we are in an ambulatory care setting, we are unable to keep a crash cart in our clinic. When these emergencies occurred, we felt unprepared to provide the best response possible to these people. According to the few articles that exist related to ambulatory care rapid response teams (RRTs), success is tied to streamlined communication, consistent processes, and implementing standard operating procedures.
Process: After our first major emergency, we identified the need for an ERT within the medical specialties clinic and an easily transportable bag that we could use to create an emergency response kit (ERK). Knowledgeable in rapid response team activation, institutional policies, clinic guidelines, and resources, the nurse manager led the development of the ERT. We used the plan-do-study-act rapid-cycle change method to help us plan and respond to this change. We planned the standard operating procedures (SOPs) we would use when the next emergency occurred and determined the contents of the emergency response kit and the order in which it would be packed (plan). We piloted the process and bag with each of the following three clinic emergencies, improving SOP consistency with each iteration (do). We met after each emergency to determine how we could streamline our process and communication and identify supplies that were unavailable during the emergency from the ERK (study). We refined the process and added to the contents of the ERK, based on the unexpected needs that arose during these emergencies (act). Nursing team leaders now run codes and other emergencies and instruct other staff when the defibrillator, CPR, suction, or ambulance is needed. Nursing team leaders take turns carrying the emergency response pager every quarter. The nursing team leader who ran the emergency within the clinic is also responsible for calling report to the emergency room when an ambulance is required. We also call surprise practice drills monthly to keep our emergency skills and readiness sharp.
Outcomes: The nursing team leaders meet with the clinic nurse manager bi-monthly to discuss incident reports and use of the emergency response kit. Emergencies are now managed confidently by team leaders and clinic staff. We have experienced two emergencies in the past three months; both were handled effectively and efficiently. We will share our 6-month post-survey results (based on Hermis, et al., 2017 and Hinkle, et al., 2021), final detailed processes, roles of our emergency team, and list and order of contents of our emergency response kit as part of our poster presentation.