QR Codes for Rapid Responses: Improved Clinical Operations and DEI Insight

Improving data collection of RRTs for quality improvement

The method we use to track rapid response team (RRT) data has evolved on our health campus at Mount Sinai Queens. Just a few years ago we were using paper logs; now we use electronic logs accessed by a QR code. The goal initially has been to become paperless and collect data to analyze our rapid responses for clinical insight. The greater data collection with the QR code process has in turn allowed for analysis, including a closer examination of diversity, equity, and inclusion (DEI) variables. 

About our rapid response team

Our RRT consists of the ICU charge nurse, ICU attending, respiratory therapist, and the nurse manager or the evening/night nursing administrator. They are called upon when there is a significant change in a patient’s condition that requires critical care expertise at the bedside. After hearing the overhead call for a rapid response, the responding ICU RN scans the RRT QR code using a smart phone. The QR code is displayed within the ICU nurses station for easy access. Depending on the type of rapid response, the responding RN can enter data into the RRT electronic log as care progresses and/or at the conclusion of the response.

Building a QR code–driven RRT electronic log

The QR code we developed allows the RN to enter specific information about the response type, location, medical record number, clinical team presence, interventions, outcome, and length of time off the unit. There are 63 potential data points per response entry. The QR code has simplified and made the processes of gathering information more efficient.

Buy-in from stakeholders

The implementation of technology in health care can provide a deeper understanding of essential data that we can use to assist, manage, and implement in our established hospital protocols. Writes Loriel Lozano, a member of our RRT team, “As a rapid response nurse, I appreciate any additional knowledge that can enhance patient treatment. This is where the QR code comes into play. The QR code enables us to identify inefficiencies in our RRT by analyzing the data obtained from our QR code log. The use of the QR code helps our hospital and health care system achieve an elevated standard of effectiveness. It improves efficiency in our nursing practice, making it easier to log and record the rapid responses that occur throughout the shift. The QR code has revolutionized our nursing practice; it is easier to use, cost-effective, and more environmentally friendly than our previous paper log format.”

Quality improvement

The transition to a QR code to collect data has given us clinical operational insights as well. For example, we now track the time the ICU nurse is off the unit. This has resulted in adjusting the way we manage our sepsis alerts. After a recent analysis during a quality improvement PDSA (plan, do, study, act), the role of the ICU RN in a sepsis alert changed, enabling the ICU nurse to remain on their unit and serve as clinical support for satellite point of care testing. Prior to the PDSA, sepsis alerts accounted for 18% of rapid response calls. This QI project resulted in approximately 28 hours annually of time added back to the ICU.

We also track the presence of the clinical team at the time the RRT arrives to the call. This has led to improved teamwork and communication, and enabled us to query clinical confidence of the primary team. The result has been an upward trend to a sustained 100% compliance of the primary team’s presence at the time of the RRT’s arrival. Additionally, with the support of the nursing education department, mock codes to build experience and confidence are now a staple.

Analysis through a DEI lens

Today we can take a deep dive, analyzing clinical insights against patient demographics, race, language, gender identity, and zip codes. For example, we can analyze the frequency of rapid response calls for sepsis, stroke, cardiac arrest, or respiratory failure and then analyze the event frequency compared to race, gender, or language spoken, and also against hospital unit. We can compare RRT event frequency by race, gender, or language to geographic home zip codes, seeking insights for vulnerability in the communities we serve. We can investigate the length of our rapid responses, outcomes, the need to upgrade to a higher level of care, the use of reversal agents, and hypo- or hyperglycemic responses by race, gender, or language spoken. The combinations seem endless.

Next steps in ensuring equitable, inclusive, high-quality care

The QR code implementation has resulted in a better understanding of our patient population. We can identify patterns of disparity or bias that may impact specific patient populations, and seek methods to change practice, find new resources, and develop awareness to change. The QR code has created another variable in our hospital and clinicians’ mission to ensure equitable and inclusive care. Collectively, these efforts will contribute to better patient outcomes and create a more inclusive and welcoming health care.

The authors of the various sections of this post all work at Mount Sinai Queens Hospital, New York City: Celest Mars, BSN, RN, CCRN, clinical nurse (“Building a QR code–driven RRT electronic log”); Loriel Lozano, BSN, RN, clinical nurse (“Buy-in from stakeholders”); Jonathan Nover, MBA, RN, senior director of nursing, Emergency Department and Critical Care Services (“Analysis through a DEI lens”); Geneline Barayuga, MSN, RN, ICU/IMCU nurse manager (“Quality improvement”); Zachary Kee, director of patient experience. A previous post by nurses at Mount Sinai Queens addressed “Improving the Discovery and Care of Pressure Injuries in the Emergency Department.”