Should Rapid Response Teams Operate in Outpatient Clinics?
This paper examines the feasibility of developing a rapid response team (RRT) protocol for outpatient clinical settings, including urgent care and walk-in centers. As demand for outpatient services grows following the Affordable Care Act, ensuring patient safety for those who may experience unexpected emergent conditions becomes increasingly important. The paper reviews established RRT protocols from the Institute for Clinical Systems Improvement, originally designed for hospital emergency departments, and evaluates their applicability to outpatient environments. It concludes that, with minor modifications, existing hospital-based RRT protocols can be meaningfully adapted to outpatient settings, though the practical need for such protocols warrants further investigation.
- Introduction: The Rise of Outpatient Care: Growth of outpatient centers and demand drivers
- The Case for Rapid Response Protocols in Outpatient Settings: Gap in RRT protocols for outpatient clinics
- Existing Rapid Response Team Protocols: ICSI hospital RRT protocol table and objectives
- Adapting Hospital RRT Protocols to Outpatient Settings: Modifying hospital objectives for outpatient use
- Conclusion: RRT adaptation feasible; need still uncertain
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What makes this paper effective
- The paper grounds its argument in concrete industry data — citing approximately 7,100 outpatient centers — giving the reader an immediate sense of scale and relevance.
- It makes disciplined use of an authoritative protocol table (adapted from the Institute for Clinical Systems Improvement) to anchor its analytical claims, rather than relying solely on prose assertion.
- The argument is tightly scoped: the author identifies exactly one inapplicable protocol item from the hospital RRT framework and proposes a specific reword, demonstrating close textual reasoning.
Key academic technique demonstrated
The paper demonstrates applied policy analysis — taking an established clinical framework (hospital RRT protocol) and systematically evaluating its transferability to a new context (outpatient settings). This technique involves identifying structural parallels, isolating points of divergence, and proposing targeted modifications rather than wholesale redesign. The use of a structured protocol table as primary evidence is an effective way to make abstract procedural content legible and arguable.
Structure breakdown
The paper opens with industry context establishing why outpatient care matters, then narrows to the specific gap: absence of RRT protocols in outpatient settings. A detailed protocol table occupies the middle section, followed by a brief but focused analysis showing that existing hospital objectives and procedures require only minor language changes to apply in outpatient environments. The conclusion is implicit rather than separately headed, folded into the final analytical paragraph.
Introduction: The Rise of Outpatient Care
Today, there are approximately 7,100 outpatient centers — also known as urgent care centers, immediate care centers, walk-in care centers, and similar facilities — that compete for patients in need of medical care (Size of industry, 2015). Outpatient care has assumed a new level of importance in the American healthcare infrastructure following the passage of the Affordable Care Act, as well as in response to the changing needs of the American population for health care services that demand more efficient, community-based resources (Ferenc, 2013). For instance, Brandenburg and Gabow (2015) emphasize that, "While excellent clinical care remains the expectation, health care consumers are now seeking health care and supporting systems that are respectful of individuals" (p. 3). Respecting individuals, of course, also means respecting their time, but anecdotal accounts and studies to date confirm that patients are kept waiting longer than necessary for a variety of reasons, all of which relate to an apparent lack of concern for patient welfare (Ferenc, 2013).
According to John Kouletsis, vice president of planning and design for Kaiser Permanente, the move toward the provision of outpatient services actually began several years ago, but it has intensified as hospital emergency rooms have become notoriously overcrowded. Kouletsis emphasizes that, "The primary drivers for many years have to do with ease of access, meeting expectations of the patients and their families, to offer high quality care. There's a huge move to providing care in the outpatient world" (cited in Ferenc, 2013, p. 22). In fact, the demand for outpatient clinic services has increased to the point where health care providers are contemplating transforming shipping containers into low-cost clinics that can be deployed quickly into communities in need — in the same manner these containers are being transformed into modern housing units (Ferenc, 2013).
There have been some attempts to improve the efficiency of outpatient clinics in recent years. For instance, Hamrock and Hopkins (2013) report that, "Some models of outpatient clinics aim to improve patient flow, reduce wait times, maximize staff utilization, and accomplish other gains in efficiency. These outpatient models are tested through changes to patient scheduling, patient routing, and internal work processes" (p. 111).
The Case for Rapid Response Protocols in Outpatient Settings
Notably absent from these initiatives, however, is an effort to develop a rapid response team (RRT) protocol capable of handling seemingly non-urgent patients who develop emergent problems after arriving at an outpatient clinic. While rapid response teams are routinely used in hospital emergency departments, far less effort has been directed toward developing these protocols for outpatient clinics (Rapid response team, 2015). According to the Institute for Clinical Systems Improvement, "The purpose of a rapid response team protocol is to provide a suitable method that enables health care staff, patients and families to directly request additional assistance from a specially trained group of individuals known as a rapid response team" (2015, p. 3).
Although the outpatient setting differs dramatically from hospital-based emergency rooms in terms of the types and severity of conditions most commonly treated, it is reasonable to posit that some patients who seek non-urgent care are in fact in need of emergency treatment. Likewise, family members and friends accompanying patients may develop medical conditions requiring emergency intervention during a visit to the outpatient clinic. Staff members themselves may also experience these types of emergencies.
Existing Rapid Response Team Protocols
The rapid response team protocols developed by the Institute for Clinical Systems Improvement are set forth in the table below.
Table 1: Rapid Response Protocols for Hospital Emergency Rooms
(Source: Adapted from Rapid Response Team Protocol, 4th ed., July 2011)
Recognition that an individual is experiencing a worrisome or acute clinical change (Annotation #1): The individual may be anyone in the health care facility.
Is the individual experiencing a behavioral health emergency? (Annotation #2): Each organization should consider developing a behavioral emergency response team (BERT) to assist staff in proactively de-escalating patients who may be exhibiting potentially violent behaviors.
Is the individual progressing toward or experiencing a cardiopulmonary arrest? (Annotation #4):
If the recognizer is a licensed health care professional, a quick assessment should be made to determine if the individual is in cardiopulmonary arrest. If the recognizer is a family member, he or she should activate the rapid response team regardless of the individual's status.
Does the individual meet criteria for rapid response team activation or demonstrate an elevated early warning score? (Annotation #6): The health care professional should also determine whether the individual's status meets the criteria for activating the rapid response team.
Activate the rapid response team (Annotation #8):
Each organization should consider a communication system that notifies the appropriate rapid response team personnel. The communication system used should be efficient and reliable. Each organization must determine when the patient's primary provider will be contacted. Organizations should also consider establishing a mechanism for patients and families to directly activate the rapid response team.
Rapid response team assesses and initiates appropriate interventions, consults with appropriate provider, and develops a continuing plan of care (Annotation #9):
A response time of less than five minutes is expected. Team members should be selected based on their clinical skills. Good communication skills and use of the Situation, Background, Assessment, Recommendation (SBAR) format is recommended. A positive attitude and respectful, supportive behavior are also recommended. The composition of the rapid response team is based on the institution's resources and needs. The rapid response team record must be initiated and included as part of the patient's permanent medical record. Rapid response team members should be trained to initiate interventions needed to stabilize the patient. If the patient is not currently an inpatient, the patient may need transfer to the emergency department. An order set may be helpful in initiating treatment. Once the patient is assessed and/or stabilized, it is recommended that the patient's primary provider be contacted and given an update, unless the primary provider has already been contacted or is present. The update to the primary provider should be delivered using the SBAR format. The team should determine with the primary provider whether the inpatient needs to be transferred to a higher level of care.
Follow-up (Annotation #17):
A member of the rapid response team may follow up in person with the patient to assess his or her status and response to the interventions. Complete documentation of the rapid response team record is required. Education should be provided when appropriate to staff and the patient involved in the event. The plan of care should be reviewed with the bedside nurse and patient. A rapid response team evaluation form should be provided to the initiator of the call. A rapid response team debrief of the event should also be conducted.
The overarching objectives of a rapid response team in hospital settings are as follows:
1. Increase early intervention and stabilization to prevent clinical deterioration of any individual prior to cardiopulmonary arrest or other life-threatening event.
2. Decrease the number of cardiopulmonary arrests that occur outside of the intensive care unit and emergency department.
3. Increase patient, family, and staff satisfaction.
4. Decrease hospital mortality (Rapid response team, 2013, p. 1).
Conclusion
It is clear that a rapid response team protocol can be developed for outpatient settings; however, the need for such protocols remains less certain. The existing hospital-based framework requires only minimal modification to function within the outpatient context, suggesting that implementation is both technically feasible and organizationally straightforward. Whether the frequency and severity of emergent events in outpatient clinics justifies the resources required to maintain a standing RRT is a question that warrants further empirical investigation.
References
Brandenburg, L. & Gabow, P. (2015, February). Innovation and best practices in health care scheduling. Washington, DC: The National Academy of Sciences.
Ferenc, J. (2013, December). Doing more with less: Hospitals use alternative methods and vacant space to construct new outpatient facilities. Health Facilities Management, 26(12), 21–25.
Hamrock, E. & Hopkins, J. (2013, March–April). Discrete event simulation for healthcare organizations: A tool for decision making. Journal of Healthcare Management, 58(2), 110–115.
Rapid response team. (2015). Institute for Clinical Systems Improvement. Retrieved from
Size of industry. (2015). Urgent Care Association of America. Retrieved from
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