Skip to main content
SpringerLink
Log in

Rapid Response Systems History and Terminology

  • Chapter
  • First Online:
Textbook of Rapid Response Systems

Abstract

The Rapid Response System (RRS) concept has matured substantially since its inception in the early 1990s when critical care physicians, primarily in Australia, Pittsburgh, PA, and the UK started asking some crucial questions regarding patients who deteriorated and often arrested on general hospital wards prior to their admission to the ICU. Specifically, they asked exactly what is happening to general hospital ward patients in the minutes and hours prior to their cardio-respiratory arrests and whether we can do something to intervene and halt these deteriorations before the patient arrests or nearly arrests. This was a sea-change in thought and perspective since, at that time, resources focused on resuscitation were primarily concerned with how to improve performance of CPR and ACLS rather than preventing the event to start with. Critical Care physicians were well aware, in a general sense, that patients admitted or readmitted to the ICU from the general ward uncommonly went from “just fine” to critically ill. This sense was confirmed by early studies that clearly showed that arrests and deteriorations were not sudden but rather commonly heralded by long periods of obvious hemodynamic and respiratory instability that was often unappreciated by general ward providers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sax FL, Charlson ME. Medical patients at high risk for catastrophic deterioration. Crit Care Med. 1987;15(5):510–515.

    Article  CAS  PubMed  Google Scholar 

  2. Schein RM, Hazday N, Pena M, Robin BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98(6):1388–1392.

    Article  CAS  PubMed  Google Scholar 

  3. Bedell SE, Deitz DC, Leeman D, Delbanco TL. Incidence and characteristics of preventable iatrogenic cardiac arrests. J Am Med Assoc. 1991;265(21):2815–2820.

    Article  CAS  Google Scholar 

  4. Daffurn K, Lee A, Hillman KM, Bishop GF, Bauman A. Do nurses know when to summon emergency assistance? Intensive Crit Care Nurs. 1994;10(2):115–120.

    Article  CAS  PubMed  Google Scholar 

  5. Smith AF, Wood J. Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. Resuscitation. 1998;37(3):133–137.

    Article  CAS  PubMed  Google Scholar 

  6. Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Med J Aust. 1999;171(1):22–25.

    CAS  PubMed  Google Scholar 

  7. Hillman KM, Bristow PJ, Chey T, Daffurn K, et al. Antecedents to hospital deaths. Intern Med J. 2001;31(6):343–348.

    Article  CAS  PubMed  Google Scholar 

  8. Hodgetts TJ, Kenward G, Vlachonikolis IG, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54(2):115–123.

    Article  PubMed  Google Scholar 

  9. Kause J, Smith G, Prytherch D, et al. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia, New Zealand, and the United Kingdom ‑ the ACADEMIA study. Resuscitation. 2004;62(3):275–282.

    Article  PubMed  Google Scholar 

  10. Hillman K, Bristow PJ, Chey T, et al. Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med. 2002;28:1629–1634.

    Article  PubMed  Google Scholar 

  11. Franklin C, Mathew J. Developing strategies to prevent in-hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22(2):244–247.

    Article  CAS  PubMed  Google Scholar 

  12. McGloin H, Adam SK, Singer M. Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? J R Coll Physicians Lond. 1999;33(37):255–259.

    CAS  PubMed  Google Scholar 

  13. Goldhill DR, White SA, Sumner A. Physiological values and procedures in the 24 h before ICU admissions from the ward. Anaesthesia. 1999;54(6):529–534.

    Article  CAS  PubMed  Google Scholar 

  14. Morgan RJM, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care. 1997;8:100.

    Google Scholar 

  15. Stenhouse C, Coates S, Tivey M, Allsop P, Parker T. Prospective evaluation of a Modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward. Br J Anaesth. 2000;84:663P.

    Google Scholar 

  16. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. Q J Med. 2001;94(10):521–526.

    CAS  Google Scholar 

  17. Hodgetts TJ, Kenward G, Vlachonikolis IG, Payne S, Castle N. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation. 2002;54(2):125–131.

    Article  PubMed  Google Scholar 

  18. Lee A, Bishop G, Hillman K, Daffurn K. The medical emergency team. Anaesth Intensive Care. 1995;23:183–186.

    CAS  PubMed  Google Scholar 

  19. Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia. 1999;54(2):853–860.

    Article  CAS  PubMed  Google Scholar 

  20. Bristow PJ, Hillman KM, Chey T, et al. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust. 2000;173(5):236–240.

    CAS  PubMed  Google Scholar 

  21. 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 cardiac arrests in hospital: preliminary study. Br Med J. 2002;324(7334):387–390.

    Article  Google Scholar 

  22. Ball C, Kirkby M, Williams S. Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. Br Med J. 2003;327(7422):1014–1016.

    Article  Google Scholar 

  23. Leary T, Ridley S. Impact of an outreach team on re-admissions to a critical care unit. Anaesthesia. 2003;58(4):328–332.

    Article  CAS  PubMed  Google Scholar 

  24. Bellomo R, Goldsmith D, Uchino S, et al. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179(6):283–287.

    PubMed  Google Scholar 

  25. Kenwood G, Castle N, Hodgetts T, Shaikh L. Evaluation of a medical emergency team one year after implementation. Resuscitation. 2004;61(3):257–263.

    Article  Google Scholar 

  26. Priestley G, Watson W, Rashidian A, et al. Introducing critical care outreach: a ward- randomised trial of phased introduction in a general hospital. Intensive Care Med. 2004;30(7):1398–1404.

    Article  PubMed  Google Scholar 

  27. Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32(4):916–921.

    Article  PubMed  Google Scholar 

  28. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13(4):251–254.

    Article  CAS  PubMed  Google Scholar 

  29. Garcea G, Thomasset S, McClelland L, Leslie A, Berry DP. Impact of a critical care outreach team on critical care readmissions and mortality. Acta Anaesthesiol Scand. 2004;48(9):1096–1100.

    Article  CAS  PubMed  Google Scholar 

  30. MERIT Study Investigators. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365(9477):2091–2097.

    Article  Google Scholar 

  31. Jones D, Bellomo R, Bates S, et al. Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care. 2005;9(6):R808–R815.

    Article  PubMed  Google Scholar 

  32. Jones D, Opdam H, Egi M, et al. Long-term effect of a medical emergency team on mortality in a teaching hospital. Resuscitation. 2007;74(2):235–241.

    Article  PubMed  Google Scholar 

  33. Jolley J, Bendyk H, Holaday B, Lombardozzi KAK, Harmon C. Rapid response teams: do they make a difference? Dimens Crit Care Nurs. 2007;26(6):253–260.

    Article  PubMed  Google Scholar 

  34. Dacey MJ, Mirza ER, Wilcox V, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35(9):2076–2082.

    Article  PubMed  Google Scholar 

  35. 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. J Am Med Assoc. 2008;300(21):2506–2513.

    Article  CAS  Google Scholar 

  36. Tibballs J, Kinney S, Duke T, Oakely E, Hennessy M. Reduction of pediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child. 2005;90(11):1148–1152.

    Article  CAS  PubMed  Google Scholar 

  37. Tibballs J, Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med. 2009;10(3):306–312.

    Article  PubMed  Google Scholar 

  38. Brilli RJ, Gibson R, Luria JW, et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med. 2007;8(3):236–246.

    Article  PubMed  Google Scholar 

  39. Sharek PJ, Parast M, Leong K, et al. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. J Am Med Assoc. 2007;298(19):2267–2274.

    Article  CAS  Google Scholar 

  40. Zenker P, Schlesinger A, Hauck M, et al. Implementation and impact of a rapid response team in a children’s hospital. Joint Comm J Qual Patient Saf. 2007;33(7):418–425.

    Google Scholar 

  41. Buist M, Harrison J, Abaloz E, Van Dyke S. Six-year audit of cardiac arrests and medical emergency team calls in an Australian teaching hospital. Br Med J. 2007;335(7631):1210–1212.

    Article  Google Scholar 

  42. 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(1):R12.

    Article  PubMed  Google Scholar 

  43. Mailey J, Digiovine B, Baillod D, Gnam G, Jordan J, Rubinfeld I. Reducing hospital standardized mortality rate with early interventions. J Trauma Nurs. 2006;13(4):178–182.

    PubMed  Google Scholar 

  44. Tolchin S, Brush R, Lange P, Bates P, Garbo JJ. Eliminating preventable death at Ascension Health. Joint Comm J Qual Patient Saf. 2007;33(3):145–154.

    Google Scholar 

  45. Offner P, Heit J, Roberts R. Implementation of a Rapid Response Team decreases cardiac arrest outside of the Intensive Care Unit. J Trauma. 2007;62(5):1223–1228.

    Article  PubMed  Google Scholar 

  46. Dacey M, Mizra R, Wilcox V, et al. The effect of a Rapid Response Team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35(9):2076–2082.

    Article  PubMed  Google Scholar 

  47. Story D, Shelton A, Poustie S, Colin-Thome N, McIntrye R, McNicol P. Effect of an anesthesia department-led critical care outreach and acute pain service on postoperative serious adverse events. Anesthesia. 2006;61:24–28.

    Article  CAS  Google Scholar 

  48. King E, Horvath R, Shulkin D. Establishing a Rapid Response Team (RRT) in an academic hospital: one year’s experience. J Hosp Med. 2006;1(5):296–305.

    Article  PubMed  Google Scholar 

  49. Hunt EA, Zimmer KP, Rinke ML, et al. Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children’s center. Arch Pediatr Adolesc Med. 2008;162(2):117–122.

    Article  PubMed  Google Scholar 

  50. K lives campaign. www.ihi.org/IHI/Programs/Campaign/Campaign. Accessed 10.07.09.

  51. Joint Commission National Patient Safety Goals. www.jointcommission.org/patientsafety/nationalpatientsafetygoals/. Accessed 10.01.10.

  52. Devita M, Bellomo R, Hillmam K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34(9):2463–2478.

    Article  PubMed  Google Scholar 

  53. Sebat F, Musthafa AA, Johnson D, et al. Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med. 2007;35(11):2568–2575.

    Article  PubMed  Google Scholar 

  54. Jones DA, McIntyre T, Baldwin I, Mercer I, Kattula A, Bellomo R. The medical emergency team and end-of-life care: a pilot study. Crit Care Resusc. 2007;9(2):151–156.

    PubMed  Google Scholar 

  55. Chen J, Flabouris A, Bellomo R, Hillman K, Finfer S. MERIT study investigators for the Simpson Center and the ANZICS Clinical Trials Group, the Medical Emergency Team System and not-for-resuscitation orders: results from the MERIT study. Resuscitation. 2008;79(3):391–397.

    Article  PubMed  Google Scholar 

  56. Jones D, Baldwin I, McIntyre T, et al. Nurses’ attitudes to a medical emergency team service in a teaching hospital. Qual Saf Health Care. 2006;15(6):427–432.

    Article  CAS  PubMed  Google Scholar 

  57. Galhotra S, Scholle CC, Dew MA, Mininni NC, Clermont G, DeVita MA. Medical emergency teams: a strategy for improving patient care and nursing work environments. J Adv Nurs. 2006;55(2):180–187.

    Article  PubMed  Google Scholar 

  58. Salamonson Y, van Heere B, Everett B, Davison P. Voices from the floor: nurses’ perceptions of the medical emergency team. Intensive Crit Care Nurs. 2006;22(3):138–143.

    Article  PubMed  Google Scholar 

  59. Buist M, Bellomo R. MET. The emergency medical team or the medical education team? Crit Care Resusc. 2004;6:88–91.

    CAS  PubMed  Google Scholar 

  60. Jones D, Bates S, Warrillow S, Goldsmith D, et al. Effect of an education programme on the utilization of a medical emergency team in a teaching hospital. Intern Med J. 2006;36(4):231–236.

    Article  CAS  PubMed  Google Scholar 

  61. Braithewaite RS, Devita MA, Mahidhara R, et al. Use of medical emergency teams (MET) responses to detect medical errors. Qual Saf Health Care. 2004;13:255–259.

    Article  Google Scholar 

  62. American Heart Association National Registry for CPR. www.nrcpr.org. Accessed 23.01.10.

  63. Cretikos M, Parr M, Hillman K, et al. Guidelines for the uniform reporting of data for Medical Emergency Teams. Resuscitation. 2006;68:11–25.

    Article  PubMed  Google Scholar 

  64. Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L. Effect of introducing the Modified Early Warning score on clinical outcomes, cardiopulmonary arrests and intensive care utilisation in acute medical admissions. Anesthesia. 2003;58(8):797–802.

    Article  CAS  Google Scholar 

  65. Goldhill DR, McNarry AF. Physiological abnormalities in early warning scores are related to mortality in adult inpatients. Br J Anaesth. 2004;92(6):882–884.

    Article  CAS  PubMed  Google Scholar 

  66. Goldhill DR, McNarry AF, Mandersloot G, McGinley A. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia. 2005;60(6):547–553.

    Article  CAS  PubMed  Google Scholar 

  67. Sharpley JT, Holden JC. Introducing an early warning scoring system in a district general hospital. Nurs Crit Care. 2004;9(3):98–103.

    Article  PubMed  Google Scholar 

  68. Gardner-Thorpe J, Love N, Wrightson J, Walsh S, Keeling N. The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Ann R Coll Surg Engl. 2006;88(6):571–575.

    Article  CAS  PubMed  Google Scholar 

  69. Jacques T, Harrison G, McLaws M, Kilborn G. Signs of critical conditions and emergency response (SOCCER): a model for predicting adverse events in the inpatient setting. Resuscitation. 2006;69:175–183.

    Article  PubMed  Google Scholar 

  70. Harrison GA, Jacques T, McLaws ML, Kilborn G. Combinations of early signs of critical illness predict in-hospital death – the SOCCER study (signs of critical conditions and emergency responses). Resuscitation. 2006;71(3):327–334.

    Article  PubMed  Google Scholar 

  71. Jacques T, Harrison GA, McLaws ML, Kilborn G. Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the in-patient setting. Resuscitation. 2006;69(2):175–183.

    Article  PubMed  Google Scholar 

  72. Subbe CP, Hibbs R, Williams E, Rutherford P, Gemmel L. ASSIST: a screening tool for critically ill patients on general medical wards. Intensive Care Med. 2002;28(suppl):S21.

    Google Scholar 

  73. Haines C, Perrott M, Weir P. Promoting care for acutely ill children. Development and evaluation of a paediatric early warning tool. Intensive Crit Care Nurs. 2006;22(2):73–81.

    Article  PubMed  Google Scholar 

  74. Duncan H, Hutchison J, Parshuram CS. The pediatric early warning system score: a severity of illness score to predict urgent medical need in hospitalised children. J Crit Care. 2006;21(13):271–279.

    Article  PubMed  Google Scholar 

  75. Subbe CP, Gao H, Harrison DA. Reproducibility of physiological track-and-trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med. 2007;33(4):619–624.

    Article  PubMed  Google Scholar 

  76. Bell MB, Konrad D, Granath F, Ekbom A, Martling CR. Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital. Resuscitation. 2006;70(1):66–73.

    Article  PubMed  Google Scholar 

  77. Green A, Williams A. An evaluation of an early warning clinical marker referral tool. Intensive Crit Care Nurs. 2006;22:274–282.

    Article  PubMed  Google Scholar 

  78. Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A. MERIT study investigators. The objective medical emergency team activation criteria: a case-control study. Resuscitation. 2007;73(1):62–72.

    Article  PubMed  Google Scholar 

  79. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Higgins B. A review, and performance evaluation, of single-parameter “track-and-trigger” systems. Resuscitation. 2008;79(1): 11–21.

    Article  PubMed  Google Scholar 

  80. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI. Review and performance evaluation of aggregate weighted “track-and-trigger” systems. Resuscitation. 2008;77(2):170–179.

    Article  PubMed  Google Scholar 

  81. Santiano N, Young L, Hillman K, et al. Analysis of medical emergency team calls comparing subjective to “objective” call criteria. Resuscitation. 2009;80(1):44–49.

    Article  PubMed  Google Scholar 

  82. Smith GB, Prytherch DR, Schmidt P, Featherstone PI, et al. Hospital-wide physiological surveillance. A new approach to the early identification and management of the sick patient. Resuscitation. 2006;71(1):19–28.

    Article  PubMed  Google Scholar 

  83. Watkinson PJ, Barber VS, Price JD, Hann A, et al. A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients. Anaesthesia. 2006;61(11):1031–1039.

    Article  CAS  PubMed  Google Scholar 

  84. Tarassenko L, Hann A, Young D. Integrated monitoring and analysis for early warning of patient deterioration. Br J Anaesth. 2006;97(1):64–68.

    Article  CAS  PubMed  Google Scholar 

  85. 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(5):326–331.

    Article  CAS  PubMed  Google Scholar 

  86. Wallin CJ, Meurling L, Hedman L, Hedegård J, Felländer-Tsai L. Target-focused medical emergency team training using a human patient simulator: effects on behaviour and attitude. Med Educ. 2007;41(2):173–180.

    Article  PubMed  Google Scholar 

  87. Jones D, Duke G, Green J, et al. Medical Emergency Team syndromes and an approach to their management. Crit Care. 2006;10(1):R30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Anesthesiology, Critical Care Medicine and Surgery, The Johns Hopkins University School of Medicine, Meyer 297 600 N Wolfe Street, Baltimore, MD, 21298, USA

    Bradford D. Winters

Authors
  1. Bradford D. Winters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael DeVita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradford D. Winters .

Editor information

Editors and Affiliations

  1. , Department of Critical Care Medicine, University of Pittsburgh Medical Center, Dewey Street 125, Edgewood, 15218-1407, Pennsylvania, USA

    Michael A. DeVita

  2. Liverpool Hospital, Dept. Intensive Care, University of New South Wales, Locked Bag 7103, Liverpool, 1871, New South Wales, Australia

    Ken Hillman

  3. Dept. Intensive Care, Austin and Repatriation Medical Centre, Studley Road, Heidelberg, 3084, Victoria, Australia

    Rinaldo Bellomo

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Winters, B.D., DeVita, M. (2011). Rapid Response Systems History and Terminology. In: DeVita, M., Hillman, K., Bellomo, R. (eds) Textbook of Rapid Response Systems. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92853-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92853-1_1

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92852-4

  • Online ISBN: 978-0-387-92853-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation