Decisive: How to Make Better Choices in Life and Work

by Chip Heath

The IHI observed that many patient emergencies could be prevented if early signs of trouble were addressed quickly, and to enable that quick response, it urged hospitals to create “rapid-response teams” (sometimes called RRTs). In a typical situation, a nurse who noticed something odd about a patient’s vitals could summon a rapid-response team, a diverse team of medical professionals who would convene quickly at the patient’s bedside to analyze the situation. The idea appealed to Leong because she knew that, while adults tend to decline gradually and predictably, kids often crater suddenly. As an experienced cardiovascular ICU nurse, Karla Earnest, said, “They hold on and hold on for a long time, then boom, they hit a wall where they can’t hold on anymore.” Often, by the time a nurse “called a code”—sounding an emergency signal that the kid’s life was at stake—it was too late to save them. The advantage of rapid-response teams, Leong knew, was that they encouraged action before it was too late, before it was necessary to call a code. She convinced her colleagues to give the idea a try. In the training sessions, the instructor passed out cards listing six tripwires that warranted calling in the RRT. Five of the tripwires involved objective measures such as acute changes in heart rate, blood pressure, or oxygen saturation. The sixth tripwire, at the top of the card, was the most important: Call the rapid-response team if you are worried about a patient.