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KEY POINTS

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KEY POINTS

  • A demand on the limited number of ICU beds requires more acute and complex patient care to be delivered on the general wards, outside of the ICU.

    Rapid response systems are designed to address this goal and rapid response teams (RRTs) or medical emergency teams (METs) have become increasingly prevalent in the US hospital systems as the means to intervene in the care of hospitalized patients with acute clinical deterioration.

  • The identification of prearrest physiology such as abnormal vital signs, or a sudden change in vital signs, can help identify clinical deterioration minutes to hours before a serious adverse event, often providing sufficient time to deliver an intervention.

  • The Society of Critical Care Medicine has identified the 5 principal admitting ICU diagnoses as respiratory failure or insufficiency, the need for postoperative management, ischemic heart disorders, sepsis, and decompensated heart failure. The correlating rapid response triggers for these conditions are often identified as hypotension, altered mental status, and respiratory distress.

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PRE-ICU SYNDROMES: RECOGNITION AND RAPID RESPONSE

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Rapid Response Teams

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The Joint Commission's National Patient Safety Goals, directs health care providers to improve the identification of clinical deterioration in hospitalized patients and select “a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient's condition appears to be worsening.”1

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Rapid response systems are designed to address this goal and RRTs or METs have become increasingly prevalent in the US hospital systems as the means to intervene in the care of hospitalized patients with acute clinical deterioration.2,3 RRTs are called to evaluate and treat not only the patients who had a cardiorespiratory arrest (for which traditional code teams exist), but also to assess patients who are having symptoms indicative of an impending cardiorespiratory or neurologic deterioration, thus supplementing traditional code teams in scope and frequency of response.2,3,4,5 RRTs may be called for signs of clinical deterioration, such as vital sign abnormalities, arrhythmias, dyspnea, and altered consciousness. A demand on the limited number of intensive care unit (ICU) beds requires more acute and complex patient care to be delivered on the general wards, outside of the ICU.6

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Rapid Response Activation

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The RRT team is activated in instances of perceived patient deterioration and recognition of clinical deterioration. RRT calls are most commonly prompted by cardiorespiratory and neurologic symptoms identified by hospital staff (clinical and nonclinical) or even family members.

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The identification of prearrest physiology such as abnormal vital signs, or a sudden change in vital signs, can help identify clinical deterioration minutes to hours before a serious adverse event, often providing sufficient time to deliver an intervention.7,8,9 Indeed, diurnal variation of RRT activation rates generally correlate with the timing of caregiver visits....

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