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Dome - A Lifesaving Shortcut

Dome September 2014

A Lifesaving Shortcut

Date: September 4, 2014

Rapid responders team with critical care transport workers to speed up emergency support in the Johns Hopkins Outpatient Center.

Rapid response team and the Lifeline critical care transport team
The Johns Hopkins Outpatient Center’s rapid response team and the Lifeline critical care transport team perform frequent code simulations to sharpen their ability to respond to a wide variety of emergencies.
photo by Keith Weller

Last winter, Johns Hopkins physician Dwight Wooster had just stepped into a crowded elevator in the Johns Hopkins Outpatient Center when he collapsed in cardiac arrest. One hospital worker immediately called a Code Blue to the Department of Emergency Medicine’s Lifeline Critical Care Transport Team’s dispatch center, while another began chest compressions on the pulseless Wooster.

In fewer than five minutes, the Outpatient Center’s rapid response team members took control of Wooster’s care. They pulled him halfway out of the elevator for better access and began resuscitation and intubation. Moments later, the Lifeline emergency transport team arrived and worked with the first responders to stabilize Wooster before rushing him by ambulance three long blocks away to The Johns Hopkins Hospital’s Emergency Department.

Swift and coordinated, the two-stage response was “lifesaving,” says Wooster, an internist and pulmonologist, who recently returned to his clinical practice and teaching duties in the school of medicine’s internal medicine clinics. Receiving care during transport by ambulance to the Emergency Department is the safest option on a campus with untold twists and turns, he says. “This is a city within a city, the way I look at it. In an emergency, you have to find the path of least resistance.”  

Shortening the path to emergency care

As the Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center neared completion several years ago, Julie Kubiak, assistant director of nursing for ambulatory care, realized that the new adult and pediatric emergency departments were a lengthy walk away, posing a patient safety risk in an emergency. Kubiak collaborated with the Lifeline Critical Care Transport Team—the critical care transport service for patients en route to or within The Johns Hopkins Hospital—to create an alternative system that would take patients to the Emergency Department from outside, instead of through the halls, underground corridor and elevators.

Kubiak and Scott Newton, assistant director of nursing for Lifeline, mapped out the two-stage emergency response plan used to transport Wooster. First, the Outpatient Center’s rapid response team—a physician, two nurses, an anesthesiologist, pharmacist and security officer—stabilizes the patient. Then, Lifeline takes over to care for and transport the patient to the Emergency Department. “That way, our team is able to stay in the building to care for other assigned patients in the Outpatient Center, minimizing interruptions in routine care,” Kubiak says.

Since the ambulatory emergency response tactic debuted more than two years ago, code calls from the Outpatient Center have doubled, from an average of six calls a month to 14. The increase could reflect higher patient volume at the Outpatient Center as well as more patients who are very sick, Kubiak says.

The calls come from clinics, outpatient surgery, Express Testing and the Outpatient Center lobby. Most concern patients and visitors who experience shortness of breath, chest pain, a fall or loss of consciousness.

Using frequent code simulations, post-response debriefings, cross-disciplinary collaboration and data analysis, the combined teams continue to sharpen their ability to respond to a wide variety of emergencies, Newton says. Their duties will soon expand. Members of the hybrid response team are now preparing to provide overnight coverage to the , located in the Outpatient Center.

—Stephanie Shapiro