114:
in the US as a rapid response team (RRT), in the UK as a critical care outreach team (CCOT), and in
Australia as a medical emergency team (MET), but rapid response team is also used generically.The team responds to calls placed by clinicians or families at the bedside who have detected deterioration. It may also provide proactive outreach to patients at high risk for deterioration. Composition of the teams may vary but often include one critical care
212:, from medical errors and delays in escalation of care despite her family’s concerns. As a result of the highly publicized death, the Children’s Hospital of Pittsburgh began a program called Condition HELP that allows families to activate a MET. Families receive training on Condition HELP when the patient is admitted and are asked to voice concerns to their care team before activating the MET.
161:. More recent work uses proximal outcome measures, such as the Children’s Resuscitation Intensity Scale (measures level of care within 12 hours pre-transfer), the Clinical Deterioration Metric (measures level of care within 12 hours post-transfer), and UNSAFE transfers (measures level of care within 1 hour post-transfer).
178:
Balancing measures evaluate any unintended consequences of the RRS. Identified barriers to activating the MET include the primary team’s overconfidence in their ability to stabilize the patient, poor communication, hierarchal problems, and hospital culture. Interventions to overcome barriers include
113:
The efferent component is a rapid response team – a multidisciplinary team trained in early resuscitation interventions, and advanced life support that rushes to the deteriorating patient’s bedside to prevent respiratory and cardiac arrest in order to improve the patient’s outcomes. The team is known
324:
DeVita, MA; Smith, GB; Adam, SK; Adams-Pizarro, I; Buist, M; Bellomo, R; Bonello, R; Cerchiari, E; Farlow, B; Goldsmith, D; Haskell, H; Hillman, K; Howell, M; Hravnak, M; Hunt, EA; Hvarfner, A; Kellett, J; Lighthall, GK; Lippert, A; Lippert, FK; Mahroof, R; Myers, JS; Rosen, M; Reynolds, S; Rotondi,
138:
The process improvement component uses evidence-based evaluation of the RRS to determine its effectiveness and to improve the system through targeted interventions. It works closely with the administrative component, clinicians (especially those on RRTs), and quality improvement experts to evaluate
575:
Devita, MA; Bellomo, R; Hillman, K; Kellum, 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 (September
169:
Process measures determine if the RRS is used as intended. Measures include the MET call rate, percentage of MET calls that result in transfer to the ICU, the time between initial physiologic abnormality and admission to ICU, timing of calls, reasons for MET calls, and evaluation of early warning
88:
The afferent component, or identification limb, also known as the track-and-trigger system, uses standardized tools to track early signs of reversible clinical deterioration and trigger a call to, and response from the efferent component, or response limb. Examples of afferent tools include
200:
METs were originally activated exclusively by bedside clinicians in need of emergency assistance. Recently, many hospitals have begun to allow families to activate a MET if they feel the care team is not adequately addressing their concerns. The team may differ in composition from the
156:
outside the intensive care unit. They also appear to decrease the chance of death in hospital. Overall effectiveness of rapid response teams is somewhat controversial due to the variability across studies as is the overall effectiveness of the rapid response system in improving
435:
Henriksen K, Battles JB, Keyes MA, Grady ML, Hueckel RM, Turi JL, Cheifetz IM, Mericle J, Meliones JN, Mistry KP. "Beyond Rapid
Response Teams: Instituting a "Rover Team" Improves the Management of At-Risk Patients, Facilitates Proactive Interventions, and Improves Outcomes".
249:
in
Australia which included vital sign ranges that differed by age group. Since its development, the RRS has been implemented around the world. The RRS became a standard of hospitals in the U.S. after its promotion by the Institute for Healthcare Improvement in 2005 and the
219:
in 2013. It allows patients, their carers, friends and family to initiate escalation of care if they are concerned that the patient is not improving as expected . By 2016 it was available in all health facilities in
Queensland. Similar policies are called "REACH" in
236:
hospitals from April 2024. It is initially being rolled out in 100 hospitals. It will allow patients, their families and carers, and hospital staff, to access a rapid review by the critical care outreach team if they are worried about the patient's condition.
1300:"What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service"
1152:
Santiano, N; Young, L; Hillman, K; Parr, M; Jayasinghe, S; Baramy, LS; Stevenson, J; Heath, T; Chan, C; Claire, M; Hanger, G (January 2009). "Analysis of medical emergency team calls comparing subjective to "objective" call criteria".
912:
Hillman, K; Chen, J; Cretikos, M; Bellomo, R; Brown, D; Doig, G; Finfer, S; Flabouris, A; MERIT study, investigators (Jun 18–24, 2005). "Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial".
1347:
Theilen, U; Leonard, P; Jones, P; Ardill, R; Weitz, J; Agrawal, D; Simpson, D (February 2013). "Regular in situ simulation training of paediatric medical emergency team improves hospital response to deteriorating patients".
1188:
Fullerton, JN; Price, CL; Silvey, NE; Brace, SJ; Perkins, GD (May 2012). "Is the
Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment?".
147:
Rates of hospital-wide mortality and respiratory and cardiac arrest, which are exceedingly rare and may or may not be preventable, are common outcome measures. Rapid response teams appear to decrease the rates of
187:
The administrative component oversees the planning, implementation, and maintenance phases for the RRS. A formal committee of frontline clinicians and ward and ICU leaders operate the administrative component.
1434:
Flynn, David E.; Flynn, Hannah; Gifford, Shaune; Smith, Kate (2022). "Can you hear me? Analysis of a
Queensland patient-initiated escalation process and the importance of communication in surgical care".
1048:
Brady, PW; Muething, S; Kotagal, U; Ashby, M; Gallagher, R; Hall, D; Goodfriend, M; White, C; Bracke, TM; DeCastro, V; Geiser, M; Simon, J; Tucker, KM; Olivea, J; Conway, PH; Wheeler, DS (January 2013).
1005:
Bonafide, CP; Roberts, KE; Priestley, MA; Tibbetts, KM; Huang, E; Nadkarni, VM; Keren, R (April 2012). "Development of a pragmatic measure for evaluating and optimizing rapid response systems".
46:. A rapid response system consists of two clinical components, an afferent component, an efferent component, and two organizational components – process improvement and administrative.
245:
Lee and colleagues developed the first reported MET in 1995 in
Liverpool Hospital in Australia. The first pediatric RRS was implemented in 2005 by Tibballs, Kinney, and colleagues at
1224:
Nembhard, IM; Edmondson AC (2006). "Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams".
793:"Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"
259:
61:
teams, and in
Australia are known as Medical emergency teams, though the term rapid response teams is often used as a generic term. In the rapid response system of a hospital's
832:
Massey, D; Aitken, LM; Chaboyer, W (Dec 2010). "Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient?".
791:
Kronick, SL; Kurz, MC; Lin, S; Edelson, DP; Berg, RA; Billi, JE; Cabanas, JG; Cone, DC; Diercks, DB; Foster, JJ; Meeks, RA; Travers, AH; Welsford, M (3 November 2015).
325:
A; Rubulotta, F; Winters, B (April 2010). ""Identifying the hospitalised patient in crisis"--a consensus conference on the afferent limb of rapid response systems".
1383:
DeVita, M, Hillman, K (2006). "Potential
Sociological and Political Barriers to Medical Emergency Team Implementation". In DeVita M, Hillman K, Bellomo R (eds.).
538:"Beyond Rapid Response Teams: Instituting a "Rover Team" Improves the Management of At-Risk Patients, Facilitates Proactive Interventions, and Improves Outcomes"
93:. These tools can predict clinical deterioration based upon the patient’s medical condition, and detect deterioration through the patient’s state such as a
179:
improved intradisciplinary staff education, protocol requiring activation when calling criteria are met, and use of “champions” to foster cultural change.
38:
designed to identify and respond to patients with early signs of clinical deterioration on non-intensive care units with the goal of preventing
204:
Family-activated METs were put in place as a response to the preventable death of Josie King in 2001. King was 18-months old when she died at
101:, diagnoses, events, subjective observations, or concerns of the patient. Multi-parameter tools are more complex in that they combine several
97:. Single-parameter calling criteria require that only one criterion be met before activating the efferent component. Criteria may be based on
1578:
255:
1694:
662:"Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: A systematic review and meta-analysis"
1255:(February 2012). "Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline".
877:
Winters, BD; Pham, JC; Hunt, EA; Guallar, E; Berenholtz, S; Pronovost, PJ (May 2007). "Rapid response systems: a systematic review".
622:
Chan, PS; Jain, R; Nallmothu, BK; Berg, RA; Sasson, C (Jan 11, 2010). "Rapid
Response Teams: A Systematic Review and Meta-analysis".
704:
Chan, PS; Jain, R; Nallmothu, BK; Berg, RA; Sasson, C (2010-01-11). "Rapid Response Teams: A Systematic Review and Meta-analysis".
414:
1663:
254:
in 2008. Outside the U.S., RRS implementation has been encouraged and adopted by several national organizations, such as the
54:
246:
225:
958:"Implementing the Bedside Paediatric Early Warning System in a community hospital: A prospective observational study"
536:
Hueckel, RĂ©mi M.; Turi, Jennifer L.; Cheifetz, Ira M.; Mericle, Jane; Meliones, Jon N.; Mistry, Kshitij P. (2008).
1530:"Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results"
1100:"'Score to Door Time', a benchmarking tool for rapid response systems: a pilot multi-centre service evaluation"
1298:
Shearer, B; Marshall, S; Buist, MD; Finnigan, M; Kitto, S; Hore, T; Sturgess, T; Wilson, S; Ramsay, W (2012).
1699:
205:
1641:
449:
216:
127:
1051:"Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events"
1642:"Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital"
542:
Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools)
481:
Acutely Ill Patients in Hospital: Recognition of and Response to Acute Illness in Adults in Hospital
362:"Effect of a Wireless Vital Sign Monitoring System on the Rapid Response System in the General Ward"
115:
90:
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437:
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299:
1599:
The Joint Commission (July 2007). "The Joint Commission 2008 National Patient Safety Goals".
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504:"Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children"
502:
Levin, Amanda B.; Brady, Patrick; Duncan, Heather P.; Davis, Aisha Barber (1 March 2015).
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57:. Rapid response teams are those specific to the US, the equivalent in the UK are called
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17:
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605:
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942:
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809:
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2006). "Findings of the first consensus conference on medical emergency teams".
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98:
1505:
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Solomon, RS; Corwin, GS; Barclay, DC; Quddusi, SF; Dannenberg, MD (June 2016).
537:
476:
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956:
Parshuram, CS; Bayliss, A; Reimer, J; Middaugh, K; Blanchard, N (March 2011).
515:
102:
1662:
Australian Commission on Safety and Quality in Health Care (September 2011).
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UK National Institute for Health and Clinical Excellence (NICE) (July 2007).
1099:
139:
three measures: outcomes measures, process measures, and balancing measures.
1545:
742:
Winters, BD; Weaver, SJ; Pfoh, ER; Yang, T; Pham, JC; Dy, SM (Mar 5, 2013).
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397:
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303:
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clinician-activated MET such as including a patient relations coordinator.
1514:
744:"Rapid-response systems as a patient safety strategy: a systematic review"
295:
282:
Jones, DA; DeVita, MA; Bellomo, R (Jul 14, 2011). "Rapid-response teams".
1528:
Tibballs, J; Kinney, S; Duke, T; Oakley, E; Hennessy, M (November 2005).
483:. National Institute for Health and Clinical Excellence (NICE). July 2007
35:
854:
69:
is sometimes used that continuously monitors the children in its care.
1448:
1409:
678:
661:
262:, and the Australian Commission on Safety and Quality in Healthcare.
119:
1237:
1119:
123:
1387:
Medical Emergency Teams: Implementation and Outcome Measurement
360:
Han, WH; Sohn, DK; Hwangbo, Y; et al. (26 August 2022).
1098:
Oglesby, KJ; Durham, L; Welch, J; Subbe, CP (Jul 27, 2011).
1487:
Lee, A; Bishop, G; Hillman, KM; Daffurn, K (April 1995).
49:
The afferent component consists of identifying the input
1404:
1402:
192:
of RRS implementation has not been rigorously studied.
53:
that alert a response from the efferent component, the
1664:"National Safety and Quality Health Service Standards"
89:
single-parameter calling criteria and multi-parameter
65:
wards a prequel to the rapid response team known as a
260:
National Institute for Health and Clinical Excellence
544:. Agency for Healthcare Research and Quality (US).
215:"Ryan's Rule" was introduced in some hospitals in
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8:
1618:Ontario Ministry of Health; Long-term Care.
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170:scores using sensitivity and specificity.
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767:
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105:into a single early warning score (EWS).
760:10.7326/0003-4819-158-5-201303051-00009
508:Current Treatment Options in Pediatrics
271:
1577:Institute for Healthcare Improvement.
458:
447:
409:
407:
34:(RRS) is a system implemented in many
477:"Evidence review and recommendations"
256:Ministry of Health and Long-term Care
7:
1362:10.1016/j.resuscitation.2012.06.027
1203:10.1016/j.resuscitation.2012.01.004
1167:10.1016/j.resuscitation.2008.08.010
339:10.1016/j.resuscitation.2009.12.008
284:The New England Journal of Medicine
1226:Journal of Organizational Behavior
891:10.1097/01.CCM.0000262388.85669.68
590:10.1097/01.CCM.0000235743.38172.6E
25:
27:Type of intervention in hospitals
1534:Archives of Disease in Childhood
846:10.1111/j.1365-2702.2010.03394.x
1391:. New York: Springer. pp.
1493:Anaesthesia and Intensive Care
1410:"Condition Help (Condition H)"
962:Paediatrics & Child Health
718:10.1001/archinternmed.2009.424
636:10.1001/archinternmed.2009.424
415:"Critical care outreach teams"
1:
1601:Joint Commission Perspectives
927:10.1016/S0140-6736(05)66733-5
706:Archives of Internal Medicine
624:Archives of Internal Medicine
1489:"The Medical Emergency Team"
810:10.1161/cir.0000000000000258
666:Journal of Hospital Medicine
226:Australian Capital Territory
1695:Critical emergency medicine
834:Journal of Clinical Nursing
748:Annals of Internal Medicine
1716:
1579:"5 Million Lives Campaign"
1506:10.1177/0310057X9502300210
1251:Mackintosh, N; Rainey, H;
379:10.1007/s10916-022-01846-8
366:Journal of medical systems
81:
1316:10.1136/bmjqs-2011-000692
1269:10.1136/bmjqs-2011-000147
516:10.1007/s40746-014-0005-1
247:Royal Children’s Hospital
1620:"Critical Care Strategy"
1257:BMJ Quality & Safety
803:(18 Suppl 2): S397–413.
183:Administrative component
1546:10.1136/adc.2004.069401
1437:ANZ Journal of Surgery
1304:BMJ Quality and Safety
1067:10.1542/peds.2012-1364
1019:10.1542/peds.2011-2784
879:Critical Care Medicine
578:Critical Care Medicine
457:Cite journal requires
206:Johns Hopkins Hospital
59:Critical care outreach
18:Medical emergency team
1414:Josie King Foundation
296:10.1056/NEJMra0910926
217:Queensland, Australia
128:respiratory therapist
95:high respiratory rate
82:Further information:
32:rapid response system
974:10.1093/pch/16.3.e18
232:" was introduced in
91:early warning scores
134:Process improvement
116:attending physician
84:Early warning score
55:rapid response team
51:early warning signs
840:(23–24): 3260–73.
754:(5 Pt 2): 417–25.
510:. pp. 76–89.
258:in Canada, the UK
190:Cost effectiveness
174:Balancing measures
1449:10.1111/ans.17584
196:Family activation
143:Outcomes measures
16:(Redirected from
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150:respiratory
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1689:Categories
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1647:18 October
1625:18 October
1584:18 October
1419:22 October
1253:Sandall, J
1055:Pediatrics
1007:Pediatrics
521:25 October
372:(10): 64.
266:References
103:parameters
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555:1 October
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420:3 October
210:Baltimore
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1669:. Sydney
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1366:PMID
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