The limitations in implementing and operating a rapid response system

Abstract

Despite the widespread introduction of rapid response systems (RRS)/medical emergency teams (MET), there is still controversy regarding how effective they are. While there are some observational studies showing improved outcomes with RRS, there are no data from randomised controlled trials to support the effectiveness. Nevertheless, the MET system has become a standard of care in many healthcare organisations. In this review, we present an overview of the limitations in implementing and operating a RRS in modern healthcare.

Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: a prospective study

“…One very recent study suggests the reverse, with more sensitive triggers combined with a two‐tier response system leading to an 82% increase in RRT calls and a 41% increase in ICU admissions, with no change in rates of death or cardiac arrests . This potential limitation of RRS, as well as others, has been described by us and endorsed by other investigators, indicating the need for more research into how RRS can be rendered more effective and efficient.…”

Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

“…Delaying GOC documentation, especially after an RRC, or lack of GOC documentation, could be an indication of system failure. 36,37 However, although RRCs may act as a trigger for GOC discussions, this may not be the most efficient use of resources. 37 Recent guidelines from the Australian Committee for Safety and Quality in Health Care (ACSQHC) about comprehensive care may provide the impetus to improve the recording of GOC plans in hospital settings, 38 by mandating systems to incorporate shared decision-making with patients early during the course of admission.…”

‘Code‐95’ rapid response calls for patients under airborne precautions in the COVID‐19‐era: a cross‐sectional survey of healthcare worker perceptions

“…Bedside afferent team members less frequently reported anxiety when escalating Code‐95 calls. This is probably because the afferent teams have habituated to a patient over time, 16 whereas the efferent teams are likely to be encountering the patient for the first time at the call 2 . There were notable differences in perceived adequacy of infection control policies and procedures between efferent and afferent teams.…”

“…Such systems involve recognition and timely activation of rapid response calls (RRC) by the home team (defined as the ‘afferent team’) and appropriate response by adequately trained and equipped medical emergency team (MET, defined as the ‘efferent team’) 1 . There is variance in rapid response team (RRT) nomenclature 2 and composition 3 across the world; however, a ‘Code Blue’ response is generally reserved for patients in life‐threatening situations who require immediate resuscitation. Many countries including Australia have mature RRS, which allow for early detection of clinical deterioration 4 .…”