Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis With In Situ Simulation

Nadav Levy, M.D.; Liana Zucco, M.B.B.S., F.R.C.A.; Richard J. Ehrlichman, M.D., F.A.C.S.; Ronald E. Hirschberg, M.D.; Stacy Hutton Johnson, Ph.D., R.N.; Michael B. Yaffe, M.D., Ph.D.; Col. (ret); Satya Krishna Ramachandran, M.D.; Somnath Bose, M.D.; Akiva Leibowitz, M.D.


Anesthesiology. 2020;133(5):985-996. 

In This Article

Lessons Learned After Implementation of a Rapid Response Team at Boston Hope

During 54 days of clinical operation, more than 700 COVID-19 patients were successfully treated at Boston Hope. Rapid response capabilities and critical care services were successfully established within 10 days from the initial planning phase. Overall, 76 encounters were registered for the critical care team, most of which were attended by direct consult rather than rapid response team activation. Complaints were categorized in order of prevalence: respiratory/hypoxia (37%), chest pain/acute (11%), electrolyte disorders (9%), arrythmias (8%), altered mental status/neurologic symptoms (7%), and abdominal symptoms (5%). Complaints with less than 5% prevalence included glycemic control, fever, pain, hypotension, falls, hypertension, and the need for ultrasound-guided venous access. Of the 76 encounters, 55 patients (72%) were successfully treated, stabilized, and observed in the acute care section, thus preventing transfer to higher-level care in surge-overwhelmed tertiary care centers in Eastern Massachusetts. The rapid response team was activated by "code" activation in three instances, which included seizures/syncope, acute coronary syndrome, and shock. These patients were treated by the rapid response team, stabilized in the acute care unit, and transferred to a tertiary center emergency department when stable. Invasive airway management was not required.