Calling Earlier: An Interprofessional TeamSTEPPS Plan to Reduce Delayed Rapid Response Activation on a Medical-Surgical Unit
[Student Name]
University of Phoenix
NSG/468: Influencing Quality within Healthcare
Week 4 Assignment
[Instructor Name]
[Date]
The unit, events and figures are a composite written for a model paper.
Rapid response teams exist to bring critical care expertise to a patient's bedside before a deterioration becomes a cardiac arrest. The team only helps if someone calls it. On a composite 36-bed medical-surgical unit, a quarterly review of five unplanned transfers to intensive care found that each patient had met at least one of the hospital's rapid response criteria between two and seven hours before the team was called. In none of the five cases did a nurse fail to notice that something was wrong; in all five, what went wrong was what happened after the nurse noticed. This paper examines those delays as a failure of interprofessional collaboration and proposes a plan built on TeamSTEPPS tools to shorten them.
The Safety Gap
Jones et al. (2011) describe rapid response systems as having an afferent limb, the detection of deterioration and the call for help, and an efferent limb, the team that responds. Most failures occur in the afferent limb. Hospitals invest heavily in the responding team but often less in making the call easy and expected. Delays in activation are associated with worse outcomes for patients, which is why the time from first abnormal criterion to call is a meaningful quality measure on its own.
The composite unit's five cases show the pattern. In three, the nurse recognized a rising respiratory rate and falling oxygen saturation, paged the covering physician and waited for a callback that took more than an hour. In one, a nursing assistant recorded a heart rate of 132 but did not report it to the nurse until the next round. In the fifth, the nurse raised concern at the charge nurse's huddle and was told to "keep an eye on it" because the patient had looked similar the day before.
Why Nurses Hesitate to Call
Astroth et al. (2013) interviewed nurses about how they decide to activate the rapid response team and found that the decision depended on more than the patient's condition. Nurses weighed their own confidence, whether they expected support or criticism from physicians and colleagues and the culture of the unit. Several described waiting to reach the primary physician first because calling the team felt like going over someone's head. The composite unit's cases match this finding. In three of the five cases, the nurse's first action was to page the physician rather than to call the team, even though the hospital's policy allowed any staff member to call when a criterion was met.
The delay therefore sits in the team, not in any one person's knowledge. The nurses knew the criteria. The nursing assistant knew the heart rate was high. The charge nurse was trying to use experience to prevent an unnecessary call. What was missing was a shared understanding across professions about who calls, when and what happens after.
The Interprofessional Plan
Interprofessional collaboration means professions working together with shared values, clear roles and communication that supports safe care (Interprofessional Education Collaborative [IPEC], 2023). TeamSTEPPS, a federal program built jointly by the defense health system and the national health care quality agency, translates those principles into teachable tools organized around communication, leadership, situation monitoring and mutual support (King et al., 2008). Weaver et al. (2014), in a narrative synthesis of team training studies in health care, found evidence that team training improves teamwork processes and, in some studies, patient outcomes, with stronger effects when training was paired with organizational support.
The plan matches one tool to each failure in the case review.
1. Structured escalation with SBAR and a time limit. When a patient meets a criterion, the nurse pages the covering physician using SBAR and calls the rapid response team if there is no bedside response within 15 minutes. The hospitalist group agreed to this rule in writing, which removes the feeling of going over a colleague's head.
2. Situation monitoring with a shared threshold. Nursing assistants report any vital sign outside set limits to the nurse immediately, using a short card with the limits and a "report now" line. The nurse acknowledges with a check-back, repeating the value, so the report is confirmed.
3. The two-challenge rule and CUS words. Any team member who is concerned may state the concern twice; if it is not addressed, the concern goes up the chain, which includes calling the team. The CUS words, which move from concern to discomfort to naming a safety issue, tell everyone present that the speaker is escalating and not complaining.
4. Huddles that change the plan. The charge nurse's huddle adds one question for every patient flagged by a nurse: what would make us call the rapid response team for this patient in the next two hours? Naming a trigger replaces "keep an eye on it."
Training is delivered together, not by profession. Nurses, nursing assistants, hospitalists and respiratory therapists attend the same 90-minute session built around the unit's own composite cases, because the tools only work when every profession expects them.
Measuring Collaboration and Safety
The unit will track three measures for six months. The main process measure is the median time from first rapid response criterion to team activation, drawn from the vital sign record and the team's call log. A second process measure is the percentage of reviewed calls in which the escalation followed the 15-minute rule. The outcome measure is the rate of unplanned moves to the intensive care unit per 1,000 patient days, with the understanding that a small unit will need a long period to show a real change. A balancing measure, rapid response calls per 1,000 patient days, is expected to rise at first; a higher call rate with shorter delays is a sign the plan is working, not a problem, but the team will review it with the rapid response nurses so the system is not overloaded.
Families are part of the plan as well. Relatives often notice a change in a patient before a vital sign does, especially confusion or unusual drowsiness in an older adult. The unit will add a short script to its admission conversation telling families how to raise a worry with the nurse and, if they are still concerned, how to ask for the rapid response team through the hospital operator, a pathway the hospital already offers but rarely explains. Including families extends situation monitoring to the people who spend the most hours at the bedside.
The plan also depends on leaders modeling it. The unit's nurse manager and the hospitalist medical director will each review the monthly call-delay data at their own staff meetings and thank, by role rather than name, the staff whose early calls led to a timely transfer. Weaver et al. (2014) found that team training effects were stronger where organizations supported them, and visible support from both professions' leaders is the simplest form that support can take.
The unit will also repeat a brief teamwork climate survey before training and at six months, because the plan's premise is that people call earlier when they expect support, and that expectation is what the survey measures.
Conclusion
Five late rapid response calls on one unit came from a team problem: nurses who noticed deterioration waited for callbacks, reports did not travel from assistants to nurses and huddles talked patients out of a call. An interprofessional plan built on TeamSTEPPS tools, agreed in writing with the physicians and taught to every profession together, targets each of those failures. Measured by the time from first criterion to call, the plan tests whether better collaboration brings help to the bedside sooner, which is the outcome that matters to the patient.
References
Astroth, K. S., Woith, W. M., Stapleton, S. J., Degitz, R. J., & Jenkins, S. H. (2013). Qualitative exploration of nurses' decisions to activate rapid response teams. Journal of Clinical Nursing, 22(19-20), 2876-2882. https://doi.org/10.1111/jocn.12067
Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies
Jones, D. A., DeVita, M. A., & Bellomo, R. (2011). Rapid-response teams. New England Journal of Medicine, 365(2), 139-146. https://doi.org/10.1056/NEJMra0910926
King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., Toomey, L., & Salisbury, M. (2008). TeamSTEPPS: Team strategies and tools to enhance performance and patient safety. In K. Henriksen, J. B. Battles, M. A. Keyes, & M. L. Grady (Eds.), Advances in patient safety: New directions and alternative approaches (Vol. 3: Performance and tools). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK43686/
Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: A narrative synthesis of the literature. BMJ Quality & Safety, 23(5), 359-372. https://doi.org/10.1136/bmjqs-2013-001848
How this NSG 468 Week 4 example is structured
The NSG/468 library guide has no separate Week 4 tab, and the course description names interprofessional collaboration as one of the three skill areas the course builds, so this model treats Week 4 as the collaboration week. The paper starts with the safety gap and its evidence, finds the cause in how the team communicates rather than in individual knowledge, and chooses tools that address that cause. Each tool is matched to a failure seen in the case review, which is what makes the plan more than a list of team training slogans. Students search this week as NSG 468 Week 4, NSG468 Wk 4 or NSG/468 Wk 4; all three are the same assignment.
NSG/468 Week 4 questions, answered
What does NSG/468 Week 4 usually ask for?
The course library guide has no separate Week 4 tab, so check your own week's instructions closely. The course description lists interprofessional collaboration alongside quality improvement and systems leadership, and many sections ask at some point for a paper or presentation on how teamwork affects a quality or safety outcome.
Do I have to use TeamSTEPPS?
No. TeamSTEPPS is widely used and well documented, which makes it convenient to cite, but any evidence-based approach to team communication, such as SBAR alone or crew resource management, can carry the paper if it is matched to the problem you describe.
Who should be on the interprofessional team in the plan?
Include the professions that actually take part in the failure you are fixing. For delayed rapid response calls that means staff nurses, charge nurses, hospitalists or residents, the rapid response nurse and respiratory therapy, and often nursing assistants, who take many of the vital signs.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.