The Impact of Delayed Rapid Response System Activation

  • Daryl A. JonesEmail author
  • Christian Subbe
  • Rinaldo Bellomo


The timely deployment of intervention by the rapid response team is crucial to patient safety. Even short delays in response from 15 to 30 min are associated with increased patient risk. Several studies have shown that patients who fulfil rapid response team call criteria but do not receive the intervention for >15 min have an increased risk of death. Such data support the important of rapid identification and deployment of treatment and imply that the rapid response system is a life-saving intervention.


Delay Rapid response team Activation Vital signs Early warning score Heart rate Glasgow coma scale Hypotension Tachypnea 


  1. 1.
    Zajac JD. The public hospital of the future. Med J Aust. 2003;250–252Google Scholar
  2. 2.
    Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T, et al. An alternative strategy for studying adverse events in medical care. Lancet. 1997;349(9048):309–313Google Scholar
  3. 3.
    Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170(11): 1678–1686Google Scholar
  4. 4.
    Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S. Adverse events in New Zealand public hospitals I: occurrence and impact. N Z Med J. 2002;115(1167):Google Scholar
  5. 5.
    Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the harvard medical practice study II. N Engl J Med. 1991;324(6):377–384Google Scholar
  6. 6.
    Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322(7285):517–519Google Scholar
  7. 7.
    Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Hamilton JD, Wilson DE, et al. The quality in Australian health care study. Med J Aust. 1995;163(12):754Google Scholar
  8. 8.
    Bell MB, Konrad D, Granath F, Ekbom A, Martling CR. Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital. Resuscitation. 2006;70(1):66–73Google Scholar
  9. 9.
    Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Med J Aust. 1999;171(1):22–25Google Scholar
  10. 10.
    Hodgetts TJ, Kenward G, Vlachonikolis IG, Payne S, CastleN. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation. 2002;54:125–131Google Scholar
  11. 11.
    Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, CastleN, CrouchR, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54(2):115–123Google Scholar
  12. 12.
    Kause J, Smith G, Prytherch D, Parr M. 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 for the Intensive Care Society (UK) & Australian and New Zealand Intensive. Resuscitation. 2004;62:275–282Google Scholar
  13. 13.
    Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999;47(5):964–969Google Scholar
  14. 14.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377Google Scholar
  15. 15.
    Fresco C, Carinci F, Maggioni AP, Ciampi A, Nicolucci A, Santoro E, et al. Very early assessment of risk for in-hospital death among 11,483 patients with acute myocardial infarction. GISSI Investigators. Am Heart J. 1999;138(6 Pt 1):1058–1064Google Scholar
  16. 16.
    Troke STS, Roup STG. Tissue plasminogen activator for acute ischemic stroke. The National Institute of neurological disorders and stroke rt-PA stroke study group. N Engl J Med. 1995;333(24):1581–1587Google Scholar
  17. 17.
    England K, Bion JF. Introduction of medical emergency teams in Australia and New Zealand: a multicentre study. Crit Care. 2008;12(3):151Google Scholar
  18. 18.
    Hillman K. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365(9477):2091–2097Google Scholar
  19. 19.
    Calzavacca P, Licari E, Tee A, Egi M, Downey A, Quach J, et al. The impact of rapid response system on delayed emergency team activation patient characteristics and outcomes—a follow-up study. Resuscitation. 2010 Jan [cited 2015 Jul 7];81(1):31–5.Google Scholar
  20. 20.
    Trinkle RM, Flabouris A. Documenting rapid response system afferent limb failure and associated patient outcomes. Resuscitation. 2011;82(7):810–814Google Scholar
  21. 21.
    Oglesby KJ, Durham L, Welch J, Subbe CP. “Score to door time”, a benchmarking tool for rapid response systems: a pilot multi-centre service evaluation. Crit Care. 2011;R180Google Scholar
  22. 22.
    Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12(6):458–464Google Scholar
  23. 23.
    Ma FT, Lee CE. Integrated control chart for vital signs early warning of long-term care patients. 2014 7th Int Conf Ubi-Media Comput Work. 2014;313–8.Google Scholar
  24. 24.
    Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A. The objective medical emergency team activation criteria: a case—control study. Resuscitation. 2007 Apr;73(1):62–72Google Scholar
  25. 25.
    Chen J, Bellomo R, Hillman K, Flabouris A, Finfer S. MERIT study investigators for the Simpson Centre and the ANZICS Clinical Trials Group. Triggers for emergency team activation: a multicenter assessment. J Crit Care. 2010;25(2):359.e1–7.CrossRefGoogle Scholar
  26. 26.
    Ludikhuize J, Borgert M, Binnekade J, Subbe C, Dongelmans D, Goossens A. Standardized measurement of the modified early warning score results in enhanced implementation of a rapid response system: a quasi-experimental study. Resuscitation. 2014;85(5):676–682Google Scholar
  27. 27.
    Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A. Respiratory rate: the neglected vital sign. Med J Aust. 2008;188(11):657–659Google Scholar
  28. 28.
    Khalid I, Qabajah MR, Hamad WJ, Khalid TJ, Digiovine B. Outcome of hypotensive ward patients who re-deteriorate after initial stabilization by the medical emergency team. J Crit Care. 2014;29(1):54–59Google Scholar
  29. 29.
    Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324(7334):387–390Google Scholar
  30. 30.
    Jones D, Opdam H, Egi M, Goldsmith D, Bates S, Gutteridge G, et al. Long-term effect of a medical emergency team on mortality in a teaching hospital. Resuscitation. 2007;74(2):235–241Google Scholar
  31. 31.
    Jones DA, McIntyre T, Baldwin I, Mercer I, Kattula A, BellomoR. The medical emergency team and end-of-life care: a pilot study. Crit Care Resusc. 2007;9(2):151–156Google Scholar
  32. 32.
    Downey AW, QuachJL, Haase M, Haase-Fielitz A, JonesD, BellomoR. Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med. 2008;36(2):477–481Google Scholar
  33. 33.
    Quach JL, Hons B, Downey AW, Hons B, Haase M, Bpharm AH, et al. Characteristics and outcomes of patients receiving a medical emergency team review for respiratory distress or hypotension. J Crit Care. 2008 Sep;23(3):325–331Google Scholar
  34. 34.
    Bucknall TK, Jones D, Bellomo R, Staples M. Responding to medical emergencies: system characteristics under examination (RESCUE). A prospective multi-site point prevalence study. Resuscitation. 2013;84(2):179–183Google Scholar
  35. 35.
    Robb G, Seddon M. A multi-faceted approach to the physiologically unstable patient. Qual Saf Health Care. 2010 Oct;19(5):e47Google Scholar
  36. 36.
    Boniatti MM, Azzolini N, Viana MV, Ribeiro BSP, Coelho RS, Castilho RK, et al. Delayed medical emergency team calls and associated outcomes. Crit Care Med. 2014;42(1):26–30Google Scholar
  37. 37.
    Mardini L, Lipes J, Jayaraman D. Adverse outcomes associated with delayed intensive care consultation in medical and surgical inpatients. J Crit Care. 2012;27(6):688–693Google Scholar
  38. 38.
    Galhotra S, DeVita MA, Simmons RL, Dew MA, Members of the Medical Emergency Response Improvement Team (MERIT) committee. Mature rapid response system and potentially avoidable cardiopulmonary arrests in hospital. Qual Saf Health Care. 2007 Aug;16(4):260–265Google Scholar
  39. 39.
    Guinane JL, Bucknall TK, Currey J, Jones DA. Missed medical emergency team activations: tracking decisions and outcomes in practice. Crit Care Resusc. 2013;15(4):266–272Google Scholar
  40. 40.
    Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, et al. Patient monitoring and the timing of cardiac arrests and medical emergency team calls in a teaching hospital. Intensive Care Med. 2006;32(9):1352–1356Google Scholar
  41. 41.
    McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998;316(7148):1853–1858Google Scholar
  42. 42.
    Jones D, Baldwin I, McIntyre T, Story D, Mercer I, Miglic A, et al. Nurses’ attitudes to a medical emergency team service in a teaching hospital. Qual Saf Health Care. 2006;15(6):427–432Google Scholar
  43. 43.
    Foraida MI, DeVita MA, Braithwaite RS, Stuart SA, BrooksMM, SimmonsRL. Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital. J Crit Care. 2003;18(2):87–94Google Scholar
  44. 44.
    Jones DA, Mitra B, Barbetti J, Choate K, Leong T, BellomoR. Increasing the use of an existing medical emergency team in a teaching hospital. Anaesth Intensive Care. 2006;731–735Google Scholar
  45. 45.
    Casamento AJ, Dunlop C, Jones DA, Duke G. Improving the documentation of medical emergency team reviews. Crit Care Resusc. 2008;10(1):29Google Scholar
  46. 46.
    Buist M, Harrison J, Abaloz E, Van Dyke S. Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. BMJ. 2007;335(7631):1210–1212Google Scholar
  47. 47.
    Moriarty JP, Schiebel NE, Johnson MG, Jensen JB, CaplesSM, MorlanBW, et al. Evaluating implementation of a rapid response team : considering alternative outcome measures. International J Qual Health Care. 2014;26(1):49–57Google Scholar
  48. 48.
    Mitchell IA, Mckay H, Van Leuvan C, BerryR, MccutcheonC, AvardB, et al. Clinical paper A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients. Resuscitation. 2010;81(6):658–666Google Scholar
  49. 49.
    Bellomo R, Ackerman M, Bailey M, Beale R, Clancy G, Danesh V, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349–2361Google Scholar
  50. 50.
    Schmidt PE, Meredith P, Prytherch DR, Watson D, Watson V, Killen RM, et al. Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual Saf. 2015;24(1):10–20Google Scholar
  51. 51.
    Umscheid CA, Betesh J, VanZandbergen C, Hanish A, Tait G, Mikkelsen ME, French B, Fuchs BD. Development,implementation, and impact of an automated early warning and response system for sepsis. J Hosp Med. 2015;10(1):26–31Google Scholar
  52. 52.
    Tirkkonen J, Ylä-Mattila J, Olkkola KT, Huhtala H, Tenhunen J, Hoppu S. Factors associated with delayed activation of medical emergency team and excess mortality: an Utstein-style analysis. Resuscitation. 2013;84(2):173–178Google Scholar
  53. 53.
    Butcher BW, Vittinghoff E, Maselli J, Auerbach AD. The impact of proactive rounding by a rapid response team on patient outcomes at an academic medical center. J Hosp Med. 2013;8(1):7–12Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Daryl A. Jones
    • 1
    Email author
  • Christian Subbe
    • 2
  • Rinaldo Bellomo
    • 1
  1. 1.Department of Intensive CareAustin HospitalHeidelberg, MelbourneAustralia
  2. 2.Ysbyty Gwynedd, PenrhosgarneddBangorUK

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