Critical Care Outreach Team (CCOT) & APP Float

Vanderbilt University Hospital approaches their Rapid Response System with a novel Advanced Practice Provider (APP) & Virtual Intensivist Model to provide high quality care for patients with acute clinical deterioration. This model, along with the specialized resources available at Vanderbilt University Medical Center, enables early recognition and response to this patient population.

Our Critical Care Outreach Team (CCOT) APPs also rotate through Vanderbilt’s Adult Critical Care Units, including Medical, Surgical, Neuroscience, Cardiac, Trauma and Burn units. This innovative staffing model strengthens support for critical care services while enhancing the clinical expertise of our CCOT APPs, equipping them with specialized knowledge to manage a wide range of patient populations during acute clinical deterioration.

  • A Rapid Response activation (RRT) is a request for specialized, critical care trained clinicians to respond and assess a patient when there is concern for acute changes or clinical deterioration.

  • At Vanderbilt University Medical Center, a Rapid Response can be activated by any patients, families, visitors, and staff within the hospital.

  • A Rapid Response can be activated when a non-intensive care patient is meeting any of the early warning signs for clinical deterioration.  

    Vanderbilt Early Warning Signs

    Staff Concern / Worry“Does not look/act right,” or a gut instinct that a patient is beginning a downward spiral
    Change in Respiratory RateRespiratory Rate < 8 or > 30
    Change in OxygenationPulse Oximeter decreases below 90% or there is an increase in oxygen requirements > 8lpm
    Labored BreathingBreathing becomes labored
    Change in Heart RateHeart Rate changes < 40 or > 120 bpm
    Change in Blood PressureSystolic Blood Pressure < 90 or > 200
    Chest PainComplains of Chest Pain
    HemorrhageDevelops uncontrolled bleeding from any site or port
    Decreased Level of ConsciousnessBecomes somnolent, difficult to arouse, confused, or obtunded
    Onset of Agitation/DeliriumBecomes agitated or delirious
    SeizureHas a seizure
    Other AlterationsAny other changes in mental status or CNS status

  • A Rapid Response can be activated by dialing 1-1111 from a Vanderbilt Phone and requesting a Rapid Response activation. Vanderbilt LifeFlight/VECOM will ask guided questions about the type of response, patient information, location, and resources needed.  

Vanderbilt CCOT Research

Peer-reviewed Publications

2025

"Video versus Direct Laryngoscopy for Tracheal Intubation Following Cardiac Arrest: a Secondary Analysis of the DEVICE Trial."
Muhs, A. L., Seitz, K. P., Qian, E. T., Imhoff, B., Wang, L., Prekker, M. E., Driver, B., Trent, S., Resnick-Ault, D., Schauer, S., Ginde, A., Russell, D., Gandotra, S., Page, D., Gaillard, J., Smith, L., Latimer, A., Mitchell, S., Johnson, N., Ghamande, S., White, H., Gibbs, K., Palakshappa, J., Vonderhaar, D., Janz, D., Whitson, M., Barnes, C., Dagan, A., Moskowitz, A., Krishnamoorthy, V., Herbert, J., April, M., Joffe, A., Walco, J., Hughes, C., Shipley, K., Maiga, A., Lloyd, B., Demasi, S., Self, W., Rice, T., Semler, M., Casey, J., & Pragmatic Critical Care Research Group. (2025).
Video versus Direct Laryngoscopy for Tracheal Intubation Following Cardiac Arrest: a Secondary Analysis of the DEVICE Trial. Chest.

"Oxygen Saturation Targets and Neurologic Outcomes Following Cardiac Arrest: A Secondary Analysis of the Pragmatic Investigation of Optimal Oxygen Targets Trial"
DeMasi, S., Clark, A., Muhs, A., Han, J., Shipley, K., McKinney, J., Wang, L., Rice, T., Moskowitz, A., Prekker, M., Johnson, N., Self, W., Case, J., Semler, M, Seitz, K., & Pragmatic Critical Care Research Group, (2025).
Oxygen Saturation Targets and Neurologic Outcomes Following Cardiac Arrest: A Secondary Analysis of the Pragmatic Investigation of Optimal Oxygen Targets Trial. Chest.

2024

"The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest"
Andrea, L., Herman, N. S., Vine, J., Berg, K. M., Choudhury, S., Vaena, M., Nogle, J., Halablab, S., Kaviyarasu, A., Elmer, J., Wardi, G., Pearce, A., Crowley, C., Long, M., Herbert, J., Shipley, K., Bissell T., Brittany D., Lanspa, M., Green, A., Ghamande, S., Khan, A., Dugar, S., Joffe, A., Baram, M., March, C., Johnson, N., Reyes, A., Denchev, K., Loewe, M., Moskowitz, A., & Society of Critical Care Medicine. (2024).
The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest. Critical Care Explorations, 6(9), e1149.

"Development and validation of a machine learning algorithm using clinical pages to predict imminent clinical deterioration"
Steitz, B. D., McCoy, A. B., Reese, T. J., Liu, S., Weavind, L., Shipley, K., ... & Wright, A. (2024).
Development and validation of a machine learning algorithm using clinical pages to predict imminent clinical deterioration. Journal of General Internal Medicine, 39(1), 27-35.

2023

"Society of Critical Care Medicine guidelines on recognizing and responding to clinical deterioration outside the ICU: 2023"
Honarmand, K., Wax, R. S., Penoyer, D., Lighthall, G., Danesh, V., Rochwerg, B., Cheatham, M., Davis, D., DeVita, M., Downar, J., Edelson, D., Fox-Robichaud, A., Fujitani, S., Fuller, R., Haskell, H., Inada-Kim, M., Jones, D., Kumar, A., Olsen, K., Rowley, D., Welch, J., Baldisseri, M., Kellett, J., Knowles, H., Shipley, K., Kolb, P., Wax, S., Hecht, J., & Sebat, F. (2024).
Society of Critical Care Medicine guidelines on recognizing and responding to clinical deterioration outside the ICU: 2023. Critical Care Medicine, 52(2), 314-330.

"Executive Summary: Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU"
Honarmand, K., Wax, R. S., Penoyer, D., Lighthall, G., Danesh, V., Rochwerg, B., Cheatham, M., Davis, D., DeVita, M., Downar, J., Edelson, D., Fox-Robichaud, A., Fujitani, S., Fuller, R., Haskell, H., Inada-Kim, M., Jones, D., Kumar, A., Olsen, K., Rowley, D., Welch, J., Baldisseri, M., Kellett, J., Knowles, H., Shipley, K., Kolb, P., Wax, S., Hecht, J., & Sebat, F. (2024).
Executive Summary: Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU. Critical Care Medicine, 52(2), 307-312

“Development and Validation of a Machine Learning Algorithm Using Clinical Pages to Predict Imminent Clinical Deterioration”
Steitz, B. D., McCoy, A. B., Reese, T. J., Liu, S., Weavind, L., Shipley, K., ... & Wright, A. (2023). Development and Validation of a Machine Learning Algorithm Using Clinical Pages to Predict Imminent Clinical Deterioration. Journal of General Internal Medicine, 1-9.

2021

“Code status at time of rapid response activation—Impact on escalation of care?”
Erath, A., Shipley, K., Walker, L. A., Burrell, E., & Weavind, L. (2021). Code status at time of rapid response activation—Impact on escalation of care?.
Resuscitation Plus, 6, 100102.

2020

“Dedicated, Proactive, Nurse Practitioner Rapid Response Team Eliminating Barriers”
Burrell, E., Kapu, A., Huggins, E., Cole, K., Fitzsimmons, J., Collins, N., & Weavind, L. (2020). Dedicated, proactive, nurse practitioner rapid response team eliminating barriers.
The Journal for Nurse Practitioners, 16(1), e17-e20.

Abstracts & Symposia

2025

Shifrin, M., Shipley, K. The Impact of a Dedicated Advanced Practice Provider Critical Care Outreach Team Model on Adult Rapid Response Team Activations, In-Hospital Cardiac Arrest Metrics, and Patient Outcomes.
American Association of Nurse Practitioners National Conference., January 2025.

Shipley, K., DeMasi, S., Schaeffer, C., Staggs, H., & McKinney, J. (2025). 1540: Prospective Identification Of In-Hospital Cardiac Arrests Across Various Levels Of Care.
Critical Care Medicine, 53(1).

Shipley, K., Shifrin, M., Pike, R., Snarskis, C., & Weavind, L. (2025). 371: Rapid Response Team Activations: A Pivotal Moment For Addressing Goals Of Care.
Critical Care Medicine, 53(1).

Shipley, K., Shifrin, M., Steitz, B., Weavind, L. 1306: Sustained Impact Of Dedicated Intensive Care Beds For Patients During Rapid Response Activations.
Critical Care Medicine 53(1):, January 2025.

Shipley, K., Shifrin, M., Snarskis, C., & Weavind, L. (2024). Abstract Su303: Afferent Rapid Response Limb Failure Prior to Non-ICU In-Hospital Cardiac Arrest and Associated In-Hospital Mortality.
Circulation, 150(Suppl_1), ASu303-ASu303.

Smith, X., Shipley, K., Brunker, L. (2024). Euglycemic Diabetic Ketoacidosis: Considerations for Rapid Response Teams and the Perioperative Setting.
IARS & SOCCA

Shifrin, M., Pike, R., Fitzsimmons, J., Weavind, L., & Shipley, K. (2024). 1309: The Impact Of Dedicated Just-In-Time ICU Beds For Adult Patients During Rapid Response Activations.
Critical Care Medicine, 52(1), S626.

Arvelo, I., Steitz, B., Shipley, K. (2023). Novel Machine Learning on Asynchronous Clinical Pages to Predict Clinical Deterioration. American Medical Informatics Association
Shipley, K., Shifrin, M. M., & Roach, K. (2023). The Impact of a Critical Care Outreach Team on the Collection of In-Hospital Cardiac Arrest Resuscitation Quality Data.
Circulation, 148(Suppl_1), A326-A326.

Burrell, E., Fitzsimmons, J., Shipley, K., Huggins, E., Roach, K., Pike, R., & Weavind, L. (2023). 304: Novel Critical Care Outreach Team Model Improving Rapid Response Outcomes.
Critical Care Medicine, 51(1), 138.

Burrell, E., Fitzsimmons, J., Shipley, K., Huggins, E., Roach, K., Pike, R., & Weavind, L. (2023). 279: Transitioning To Comfort During Rapid Response Activation Without ICU Escalation.
Critical Care Medicine, 51(1), 124.

Shipley, K., Burrell, E., Huggins, E., Fitzsimmons, J., Roach, K., Pike, R., & Weavind, L. (2023). 1043: Quality Data Collection in Rapid Response Systems.
Critical Care Medicine, 51(1), 516.

2024

“The Impact of Dedicated Just-in-Time ICU Beds for Adult Patients During Rapid Response Activations”
Shipley, K., Shifrin, M., Pike, R., Fitzsimmons, J., &Weavind, L. (2024). 1309: The impact of dedicated just-in-time icu beds for adult patients during rapid response activations. Critical Care Medicine, 52(1), S626.
Society of Critical Care Medicine Congress 2024, Phoenix, Arizona

2023

"Unrecognized Clinical Deterioration Prior to In-Hospital Cardiac Arrest and Associated In-Hospital Mortality”
Shipley, K., Shifrin, M. M., & Roach, K. (2023). Unrecognized Clinical Deterioration Prior to In-Hospital Cardiac Arrest and Associated In-Hospital Mortality. Circulation, 148(Suppl_1), A329-A329.
American Heart Association Resuscitation Science Symposium 2023, Philadelphia, Pennsylvania

“Quality Data Collection In Rapid Response Systems”
Shipley, K., Burrell, E., Huggins, E., Fitzsimmons, J., Roach, K., Pike, R., & Weavind, L. (2023). 1043: Quality Data Collection In Rapid Response Systems. Critical Care
Society of Critical Care Medicine Congress 2023, San Francisco, California

“An Evaluation of MEWS, NEWS, and a Widely Available Proprietary Deterioration Index”
Steitz, B., Shipley, K., Burrell, E., Wright, A., Fitzsimmons, J., Huggins, E., ... & Weavind, L. (2023). 1033: An Evaluation Of Mews, News, And A Widely Available Proprietary Deterioration Index. Critical Care Medicine, 51(1), 511.
Society of Critical Care Medicine Congress 2023, San Francisco, California

“Novel Critical Care Outreach Team Model Improving Rapid Response Outcomes”
Burrell, E., Fitzsimmons, J., Shipley, K., Huggins, E., Roach, K., Pike, R., & Weavind, L. (2023). 304: Novel Critical Care Outreach Team Model Improving Rapid Response Outcomes. Critical Care Medicine, 51(1), 138.
Society of Critical Care Medicine Congress 2023, San Francisco, California

“Transitioning to Comfort During Rapid Response Activation Without ICU Escalation”
Burrell, E., Fitzsimmons, J., Shipley, K., Huggins, E., Roach, K., Pike, R., & Weavind, L. (2023). 279: Transitioning To Comfort During Rapid Response Activation Without Icu Escalation. Critical Care Medicine, 51(1), 124.
Society of Critical Care Medicine Congress 2023, San Francisco, California