Rapid response systems
- Michael D Howell, MD, MPH
Michael D Howell, MD, MPH
- Associate Professor of Medicine
- University of Chicago
- Jennifer P Stevens, MD, MS
Jennifer P Stevens, MD, MS
- Assistant Professor of Medicine
- Harvard Medical School
Rapid response systems identify deteriorating hospitalized patients prospectively and seek to alter their clinical trajectory through increasing the clinical resources directed to them . As hospitalized patients may exhibit warning signs prior to deterioration [2,3], rapid response systems have the potential to prevent adverse clinical outcomes, including cardiac arrest and death.
Rapid response systems are being utilized increasingly throughout the world, particularly in developed countries [4,5]. In 2005, the Institute for Healthcare Improvement made implementation of rapid response systems a key part of the 100,000 Lives Campaign to improve the quality of care in hospitals and reduce mortality rates . However, the evidence supporting rapid response systems is limited, and it remains controversial whether these systems of care are effective [7,8].
In this topic, we discuss the rationale for rapid response systems and current evidence for their use in adults. Rapid response systems in the pediatric population and specific treatments in the management of critically ill patients are reviewed separately. (See "Pediatric advanced life support (PALS)", section on 'Rapid response teams' and "Overview of sudden cardiac arrest and sudden cardiac death" and "Advanced cardiac life support (ACLS) in adults".)
Rapid response systems are programs that are designed to improve the safety of hospitalized patients whose condition is deteriorating quickly . They are based on prospective identification of high-risk patients, early notification of a team of responders who have been preselected and trained, rapid intervention by the response team, and ongoing evaluation of the system’s performance.
Several terms are used to refer to rapid response systems. These terms include critical care outreach, medical emergency teams, medical response teams, and rapid response teams. There are subtle differences between these terms, but all maintain two key features: an afferent limb (ie, how the team is activated) and an efferent limb (ie, the response of the team). Medical emergency teams typically refer to physician-led teams that have the ability to manage complex airway issues, establish central access, and initiate intensive care unit (ICU) level care at the bedside . Rapid response teams are generally nurse-led teams . Critical care outreach is slightly different from the other terms in that critical care outreach also focuses on educating non-critical care staff and improving transfers between ICUs and the general hospital wards.
- Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med 2011; 365:139.
- Schein RM, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 1990; 98:1388.
- Kause J, Smith G, Prytherch D, et al. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study. Resuscitation 2004; 62:275.
- Steel AC, Reynolds SF. The growth of rapid response systems. Jt Comm J Qual Patient Saf 2008; 34:489.
- Edelson DP, Yuen TC, Mancini ME, et al. Hospital cardiac arrest resuscitation practice in the United States: a nationally representative survey. J Hosp Med 2014; 9:353.
- Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295:324.
- Winters BD, Pham J, Pronovost PJ. Rapid response teams--walk, don't run. JAMA 2006; 296:1645.
- Litvak E, Pronovost PJ. Rethinking rapid response teams. JAMA 2010; 304:1375.
- Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006; 34:2463.
- Jones D, Baldwin I, McIntyre T, et al. Nurses' attitudes to a medical emergency team service in a teaching hospital. Qual Saf Health Care 2006; 15:427.
- Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 2004; 32:916.
- Parr MJ, Hadfield JH, Flabouris A, et al. The Medical Emergency Team: 12 month analysis of reasons for activation, immediate outcome and not-for-resuscitation orders. Resuscitation 2001; 50:39.
- Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003; 58:297.
- Ehlenbach WJ, Barnato AE, Curtis JR, et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009; 361:22.
- Buist M, Bernard S, Nguyen TV, et al. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation 2004; 62:137.
- Kollef MH, Chen Y, Heard K, et al. A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team. J Hosp Med 2014; 9:424.
- Huh JW, Lim CM, Koh Y, et al. Activation of a medical emergency team using an electronic medical recording-based screening system*. Crit Care Med 2014; 42:801.
- Chan PS, Khalid A, Longmore LS, et al. Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA 2008; 300:2506.
- Konrad D, Jäderling G, Bell M, et al. Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med 2010; 36:100.
- Hodgetts TJ, Kenward G, Vlackonikolis I, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation 2002; 54:115.
- McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998; 316:1853.
- Sprung CL, Geber D, Eidelman LA, et al. Evaluation of triage decisions for intensive care admission. Crit Care Med 1999; 27:1073.
- Young MP, Gooder VJ, McBride K, et al. Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity. J Gen Intern Med 2003; 18:77.
- Boniatti MM, Azzolini N, Viana MV, et al. Delayed medical emergency team calls and associated outcomes. Crit Care Med 2014; 42:26.
- Parkhe M, Myles PS, Leach DS, Maclean AV. Outcome of emergency department patients with delayed admission to an intensive care unit. Emerg Med (Fremantle) 2002; 14:50.
- McGillicuddy DC, O'Connell FJ, Shapiro NI, et al. Emergency department abnormal vital sign "triggers" program improves time to therapy. Acad Emerg Med 2011; 18:483.
- Priestley G, Watson W, Rashidian A, et al. Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med 2004; 30:1398.
- Jones DA, McIntyre T, Baldwin I, et al. The medical emergency team and end-of-life care: a pilot study. Crit Care Resusc 2007; 9:151.
- Smith RL, Hayashi VN, Lee YI, et al. The medical emergency team call: a sentinel event that triggers goals of care discussion. Crit Care Med 2014; 42:322.
- Sulistio M, Franco M, Vo A, et al. Hospital rapid response team and patients with life-limiting illness: a multicentre retrospective cohort study. Palliat Med 2015; 29:302.
- Winters BD, Weaver SJ, Pfoh ER, et al. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med 2013; 158:417.
- Solomon RS, Corwin GS, Barclay DC, et al. Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: A systematic review and meta-analysis. J Hosp Med 2016; 11:438.
- Barwise A, Thongprayoon C, Gajic O, et al. Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution. Crit Care Med 2016; 44:54.
- Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005; 365:2091.
- Bonafide CP, Localio AR, Song L, et al. Cost-benefit analysis of a medical emergency team in a children's hospital. Pediatrics 2014; 134:235.