Skip to main content
SpringerLink
Log in

Rapid Response Systems: Are they Really Effective?

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2015

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2015 ((AUICEM,volume 2015))

  • 2563 Accesses

Abstract

Despite the immediate availability of qualified life support, the outcome of in-hospital cardiac arrest (IHCA) remains poor, with survival to discharge rarely exceeding 20% [1]. However, more than half of all cardiopulmonary arrests are preceded by deterioration in vital signs [2, 3], which are often not appropriately evaluated, suggesting that many of these adverse events could be prevented by early identification and treatment [4].

In-hospital rapid response systems have been established to manage unstable patients in general wards, with the aim of preventing further deterioration leading to cardiac arrest [5]. Implementation of a rapid response system includes education of the ward staff (the afferent limb of the system) to systematically detect signs of physiological instability and identify patients needing urgent evaluation by a medical emergency team (MET). The MET (the efferent limb of the system) includes medical doctors and/or nurses experienced in management of critical patients; it is activated by ward staff in patients fulfilling specific criteria or in response to staff concerns, and its roles are to stabilize the patient in the ward or move the patient to a higher level of care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245

    Article  PubMed  Google Scholar 

  2. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL (1990) Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 98:1388–1392

    Article  CAS  PubMed  Google Scholar 

  3. Hillman KM, Bristow PJ, Chey T et al (2001) Antecedents to hospital deaths. Intern Med J 31:343–348

    Article  CAS  PubMed  Google Scholar 

  4. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP (2007) Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 35:1477–1483

    Article  PubMed  Google Scholar 

  5. DeVita MA, Smith GB, Adam SK et al (2010) “Identifying the hospitalised patient in crisis” – a consensus conference on the afferent limb of rapid response systems. Resuscitation 81:375–382

    Article  PubMed  Google Scholar 

  6. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C (2010) Rapid response teams: A systematic review and meta-analysis. Arch Intern Med 170:18–26

    Article  PubMed  Google Scholar 

  7. Hillman K, Chen J, Cretikos M et al (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097

    Article  PubMed  Google Scholar 

  8. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV (2002) Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 324:387–390

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kenward G, Castle N, Hodgetts T, Shaikh L (2004) Evaluation of a medical emergency team one year after implementation. Resuscitation 61:257–263

    Article  PubMed  Google Scholar 

  10. Smith RL, Hayashi VN, Lee YI, Navarro-Mariazeta L, Felner K (2014) The medical emergency team call: a sentinel event that triggers goals of care discussion. Crit Care Med 42:322–327

    Article  PubMed  Google Scholar 

  11. Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA (2008) Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA 300:2506–2513

    Article  CAS  PubMed  Google Scholar 

  12. Sherner JH (2009) Rapid response team implementation and hospital mortality rates. JAMA 301:1658–1659

    Article  CAS  PubMed  Google Scholar 

  13. Bristow PJ, Hillman KM, Chey T et al (2000) Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 173:236–240

    CAS  PubMed  Google Scholar 

  14. Al-Qahtani S, Al-Dorzi HM, Tamim HM et al (2013) Impact of an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. Crit Care Med 41:506–517

    Article  PubMed  Google Scholar 

  15. Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L (2003) Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia 58:797–802

    Article  CAS  PubMed  Google Scholar 

  16. Simmes FM, Schoonhoven L, Mintjes J, Fikkers BG, van der Hoeven JG (2012) Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system. Ann Intensive Care 2:20

    Article  PubMed Central  PubMed  Google Scholar 

  17. Bellomo R, Goldsmith D, Uchino S et al (2003) A prospective before-and-after trial of a medical emergency team. Med J Aust 179:283–287

    PubMed  Google Scholar 

  18. Konrad D, Jaderling G, Bell M, Granath F, Ekbom A, Martling CR (2010) Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med 36:100–106

    Article  PubMed  Google Scholar 

  19. Santamaria J, Tobin A, Holmes J (2010) Changing cardiac arrest and hospital mortality rates through a medical emergency team takes time and constant review. Crit Care Med 38:445–450

    Article  PubMed  Google Scholar 

  20. Beitler JR, Link N, Bails DB, Hurdle K, Chong DH (2011) Reduction in hospital-wide mortality after implementation of a rapid response team: a long-term cohort study. Crit Care 15:R269

    Article  PubMed Central  PubMed  Google Scholar 

  21. Laurens N, Dwyer T (2011) The impact of medical emergency teams on ICU admission rates, cardiopulmonary arrests and mortality in a regional hospital. Resuscitation 82:707–712

    Article  PubMed  Google Scholar 

  22. Tobin AE, Santamaria JD (2012) Medical emergency teams are associated with reduced mortality across a major metropolitan health network after two years service: a retrospective study using government administrative data. Crit Care 16:R210

    Article  PubMed Central  PubMed  Google Scholar 

  23. Chen J, Ou L, Hillman KM et al (2014) Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion. Med J Aust 201:167–170

    Article  PubMed  Google Scholar 

  24. Dacey MJ, Mirza ER, Wilcox V et al (2007) The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med 35:2076–2082

    Article  PubMed  Google Scholar 

  25. Baxter AD, Cardinal P, Hooper J, Patel R (2008) Medical emergency teams at The Ottawa Hospital: the first two years. Can J Anaesth 55:223–231

    Article  PubMed  Google Scholar 

  26. Jolley J, Bendyk H, Holaday B, Lombardozzi KA, Harmon C (2007) Rapid response teams: do they make a difference? Dimens Crit Care Nurs 26:253–260

    Article  PubMed  Google Scholar 

  27. Campello G, Granja C, Carvalho F, Dias C, Azevedo LF, Costa-Pereira A (2009) Immediate and long-term impact of medical emergency teams on cardiac arrest prevalence and mortality: a plea for periodic basic life-support training programs. Crit Care Med 37:3054–3061

    Article  PubMed  Google Scholar 

  28. Lighthall GK, Parast LM, Rapoport L, Wagner TH (2010) Introduction of a rapid response system at a United States veterans affairs hospital reduced cardiac arrests. Anesth Analg 111:679–686

    Article  PubMed  Google Scholar 

  29. Jones D, Bellomo R, Bates S et al (2005) Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9:R808–R815

    Article  PubMed Central  PubMed  Google Scholar 

  30. Hatler C, Mast D, Bedker D et al (2009) Implementing a rapid response team to decrease emergencies outside the ICU: one hospital’s experience. Medsurg Nurs 18:84–90

    PubMed  Google Scholar 

  31. Sarani B, Palilonis E, Sonnad S et al (2011) Clinical emergencies and outcomes in patients admitted to a surgical versus medical service. Resuscitation 82:415–418

    Article  PubMed  Google Scholar 

  32. Sandroni C, Cavallaro F (2011) Failure of the afferent limb: a persistent problem in rapid response systems. Resuscitation 82:797–798

    Article  PubMed  Google Scholar 

  33. Trinkle RM, Flabouris A (2011) Documenting Rapid Response System afferent limb failure and associated patient outcomes. Resuscitation 82:810–814

    Article  PubMed  Google Scholar 

  34. Calzavacca P, Licari E, Tee A et al (2010) The impact of Rapid Response System on delayed emergency team activation patient characteristics and outcomes – a follow-up study. Resuscitation 81:31–35

    Article  PubMed  Google Scholar 

  35. Buist M, Harrison J, Abaloz E, Van Dyke S (2007) Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. BMJ 335:1210–1212

    Article  PubMed Central  PubMed  Google Scholar 

  36. Chen J, Ou L, Hillman K et al (2014) The impact of implementing a rapid response system: A comparison of cardiopulmonary arrests and mortality among four teaching hospitals in Australia. Resuscitation 85:1275–1281

    Article  PubMed  Google Scholar 

  37. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL (2004) Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 13:251–254

    Google Scholar 

  38. Priestley G, Watson W, Rashidian A et al (2004) Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med 30:1398–1404

    Google Scholar 

  39. Shah SK, Cardenas VJ, Jr., Kuo YF, Sharma G (2011) Rapid response team in an academic institution: does it make a difference? Chest 139:1361–1367

    Google Scholar 

  40. Howell MD, Ngo L, Folcarelli P et al (2012) Substained effectiveness of a primary-team-based rapid response system. Crit Care Med 40:2562–2568

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy

    C. Sandroni, S. D’Arrigo & M. Antonelli

Authors
  1. C. Sandroni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. D’Arrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Antonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Antonelli .

Editor information

Editors and Affiliations

  1. Université libre de Bruxelles, Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent Prof.

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland and BioMed Central Ltd.

About this chapter

Cite this chapter

Sandroni, C., D’Arrigo, S., Antonelli, M. (2015). Rapid Response Systems: Are they Really Effective?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13761-2_40

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13760-5

  • Online ISBN: 978-3-319-13761-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation