Abstract
There is growing evidence that early detection and response to physiological deterioration can improve outcomes for hospitalized infants, children, and adults. A rapid response system (RRS) is a multidisciplinary system to decrease the incidence of in-hospital cardiopulmonary arrests by detecting a crisis event and triggering a response and by dispatching a responding team. For quality improvement of the system, a review mechanism is vital to identify opportunities for preventing future events or improving response after crises occur. The whole system requires an administrative component that oversees the RRS and provides support. The system is designed to locate and respond rapidly to a suddenly critically ill patient who lacks necessary critical care resources. Over the past decade, RRSs have been widely implemented in adult practice in the United States, Canada, Australia, the United Kingdom, and Scandinavian countries.
Similar content being viewed by others
References
Smith AF, Wood J. Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. Resuscitation. 1998;37:133–137.
Schein RMH, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388–1392.
Hodgetts TJ, Kenward G, Vlackonikolis L, Castle N, Crouch R, Ineson N, Shaikh L. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54:115–123.
Nurmi J, Harjola VP, Nolan J, Castrén M. Observations and warning signs prior to cardiac arrest. Should a medical emergency team intervene earlier? Acta Anaesthesiol Scand. 2005;49:702–706.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32:916–921.
Kohn LT, Corrigan JM, Donaldson MS, editors; Committee on Quality of Health Care in America, Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy; 2000.
Devita MA, Bellomo R, Hillman K, J, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milbrandt E, Peberdy M, Savitz L, Young L, Harvey M, Galhotra S. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34:2463–2678.
Galhotra S, DeVita MA, Simmons RL, Schmid A; members of the Medical Emergency Response Improvement Team (MERIT) Committee. Impact of patient monitoring on the diurnal pattern of medical emergency team activation. Crit Care Med. 2006;34:1700–1706.
Burch VC, Tarr G, Morroni C. Modified early warning score predicts the need for hospital admission and inhospital mortality. Emerg Med J. 2008;25:674–678.
Groarke JD, Gallagher J, Stack J, Aftab A, Dwyer C, McGovern R, Courtney G. Use of an admission early warning score to predict patient morbidity and mortality and treatment success. Emerg Med J. 2008;25:803–806.
Braithwaite RS, DeVita MA, Mahidhara R, Simmons RL, Stuart S, Foraida M; Medical Emergency Response Improvement Team (MERIT). Use of medical emergency team (MET) responses to detect medical errors. Qual Saf Health Care. 2004;13:255–259.
DeVita MA, Schaefer J, Lutz J, Wang H, Dongilli T. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care. 2005;14:326–331.
Peberdy MA, Cretikos M, Abella BS, DeVita M, Goldhill D, Kloeck W, Kronick SL, Morrison LJ, Nadkarni VM, Nichol G, Nolan JP, Parr M, Tibballs J, van der Jagt EW, Young L; International Liaison Committee on Resuscitation; American Heart Association; Australian Resuscitation Council; European Resuscitation Council; Heart and Stroke Foundation of Canada; Inter-American Heart Foundation; Resuscitation Council of Southern Africa; New Zealand Resuscitation Council; American Heart Association Emergency Cardiovascular Care Committee; American Heart Association Council on Cardiopulmonary, Perioperative, and Critical Care; Interdisciplinary Working Group on Quality of Care and Outcomes Research. Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement: a scientific statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian Resuscitation Council, European Resuscitation Council, Heart and Stroke Foundation of Canada, Inter American Heart Foundation, Resuscitation Council of Southern Africa, and the New Zealand Resuscitation Council); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2007;116:2481–2500.
Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D’Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D; International Liaison Committee on Resuscitation; American Heart Association; European Resuscitation Council; Australian Resuscitation Council; New Zealand Resuscitation Council; Heart and Stroke Foundation of Canada; Inter American Heart Foundation; Resuscitation Council of Southern Africa; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, Inter American Heart Foundation, Resuscitation Council of Southern Africa). Circulation. 2004;110:3385–3397.
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 cardiopulmonary arrests in hospital: a preliminary study. BMJ. 2002;324:387–390.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179:283–288.
DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL Medical Emergency Response Improvement Team (MERIT). Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13:251–254.
Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A; MERIT study investigators. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365:2091–2097.
Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA. Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA. 2008;300:2506–2513.
Chen J, Bellomo R, Flabouris A, Hillman K, Finfer S; MERIT Study Investigators for the Simpson Centre; ANZICS Clinical Trials Group. The relationship between early emergency team calls and serious adverse events. Crit Care Med. 2009;37:148–153.
Jones D, Opdam H, Egi M, Goldsmith D, Bates S, Gutteridge G, Kattula A, Bellomo R. Long-term effect of a medical emergency team on mortality in a teaching hospital. Resuscitation. 2007;74:235–241.
Jones D, Egi M, Bellomo R, Goldsmith D. Effect of the medical emergency team on long-term mortality following major surgery. Crit Care. 2007;11:R12.
DeVita MA, Bellomo R. The case of rapid response systems: are randomized clinical trials the right methodology to evaluate systems of care? Crit Care Med. 2007;35:1413–1414.
Foraida MI, DeVita MA, Braithwaite RS, Stuart SA, Brooks MM, Simmons RL. Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital. J Crit Care. 2003;18:87–94.
Grenvik A, Schaefer JJ 3rd, DeVita MA, Rogers P. New aspects on critical care medicine training. Curr Opin Crit Care. 2004;10:233–237.
Author information
Authors and Affiliations
About this article
Cite this article
Sakai, T., DeVita, M.A. Rapid response system. J Anesth 23, 403–408 (2009). https://doi.org/10.1007/s00540-009-0778-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-009-0778-8