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CHAPTER 12: Rapid Response Teams

Daryl Jones; Rinaldo Bellomo

KEY POINTS

  • Patients admitted to modern hospitals may develop serious adverse events in up to 20% of admissions. In addition, hospitalized patients can deteriorate unexpectedly due to the development of a new problem.

  • In a high percentage of cases, deterioration is gradual in onset and is associated with the development of derangement in the patient's vital signs.

  • Many hospitals have introduced Rapid Response Teams (RRTs) to review deteriorating patients when they develop derangements in vital signs that fulfill predefined criteria.

  • Evidence for the effectiveness of RRTs is conflicting, and the optimal team composition and thresholds for activation remain undetermined.

INTRODUCTION

Modern hospitals treat patients with increasingly complex medical conditions. Despite advances in medical technology and the advent of new medicines and interventions, many patients admitted to hospitals suffer adverse events. The most studied of these events are unplanned admissions to the intensive care unit (ICU), unexpected hospital deaths, and cardiac arrests. Other studies have shown that such events are preceded by the development of new problems or derangements in vital signs for several hours, and that the response to these problems by ward staff may be suboptimal.

Traditional code teams are activated when a patient suffers a cardiac arrest manifesting as a loss of circulation or respiration. In this chapter, we discuss the concept of the Rapid Response Team (RRT), which is activated when a patient develops less severe and earlier signs of instability. We also describe the Rapid Response System (RRS), which is the entire system used to support the team.

SERIOUS ADVERSE EVENTS ARE COMMON IN HOSPITALIZED PATIENTS

Modern hospitals in developed countries care for patients of increasing age, acuity, and complexity.1 Studies conducted in North America, Australia, New Zealand, and the United Kingdom suggest that such patients suffer adverse events in up to 20% of cases depending on the definition used and population assessed (Table 12-1).

TABLE 12-1

Summary of Studies Reporting Adverse Events in Hospitalized Patients

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TABLE 12-1

Summary of Studies Reporting Adverse Events in Hospitalized Patients
Reference(s) and Year of Inception Study Population Definition of Adverse Events Major Findings
Schimmel2 1960-1961 1014 patients admitted over 8 months to a university-affiliated hospital Every noxious response to medical care occurring among patients…resulting from acceptable diagnostic and therapeutic measures deliberately instituted at the hospital

  • 20% suffered iatrogenic injury

  • 6.7% of adverse events resulted in death

  • LOS in those with noxious events was 28.7 days compared with 11.4 days in other patients
Leape et al,3 1984 30,195 patients in 51 hospitals in New York Unintended injury that was caused by medical management that resulted in measurable disability

  • 3.7% incidence of adverse events

  • 47.7% associated with operation

  • Drug error, wound infection, and technical complication responsible for 45.9% of events
Thomas et al,4 1992 14,700 patients ...

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