Although rapid response teams have been widely advocated, the evidence for their benefit remains mixed. This observational study sought to analyze the incidence of inpatient cardiopulmonary arrest and related mortality while rapid response teams were being implemented in Australia. Between 2002 and 2009, the mortality associated with inpatient cardiopulmonary arrests decreased over time. The authors found that most of the decline was due to decreased incidence of arrest, not increased survival following arrest. This finding suggests that rapid response did not play a significant role in reducing mortality from in-hospital arrest in this population, consistent with prior studies.

In this study, conducted at seven hospitals in three countries, nearly one-third of patients seen by a rapid response team ultimately had limitations placed on their care (such as do-not-resuscitate orders). This finding indicates a need for improved advanced care planning.

Delays in clinical deterioration recognition and failures to rescue lead to serious adverse events. Rapid response systems (RRS) have been implemented with the aim of improving the identification and management of clinically worsening hospital ward patients. Although early studies reviewing RRS showed improvements in clinical outcomes, subsequent results have not shown consistent benefit. This review describes RRS, including controversies surrounding them, potential benefits and limitations, as well as strategies to implement them successfully. An AHRQ WebM&M perspective discusses lessons from early experiences with RRS.

Atrial fibrillation, a common cardiac arrhythmia, triggered a significant proportion of rapid response system activations at an Australian hospital, and was associated with worsened clinical outcomes.

The most common reason for rapid response system activation was concern on the part of a staff member (usually the bedside nurse). Objective criteria, such as vital sign abnormalities, were not used as frequently.

Nearly all of the calls to a rapid response team in this large Australian study required critical care interventions such as airway management or use of inotropic drugs. Calls were also significantly more common during morning hours.

Rapid response systems (RRS), implemented to treat the clinically deteriorating patient, have now been well studied, including studies examining their impact on cardiac arrests, mortality, and even end-of-life care. This observational cohort study compared the use of and outcomes from medical emergency teams (MET) 5 years after their implementation to those found at the time of initiation. The study found fewer unplanned ICU admissions and MET activation delays in experienced systems, suggesting that RRS may need to mature before their full impact is felt. This finding adds to the ongoing debate about and tension regarding the impact of RRS. A past AHRQ WebM&M perspective discussed early lessons from rapid response team implementation.

Nurses in this study valued medical emergency team (MET) systems, but they also pointed out barriers to activation, including fear of criticism and adherence to the more traditional model of contacting the responsible physician first. Fear of criticism was a finding not reported in a past study of nursing attitudes about MET systems.

The largest study of rapid response systems to date, the MERIT trial was conducted in 23 Australian hospitals and did not demonstrate overall improvement in clinical outcomes. However, a limitation of this study was that the rapid response team was not actually called to evaluate the majority of patients who subsequently suffered a cardiac arrest. This retrospective analysis of data from the same study found evidence for a "dose-response" relationship between rapid response team use and clinical outcomes, in that early activation of the team was associated with a reduction in cardiac arrests.

Implementation of a medical emergency team improved documentation of vital signs, but did not improve clinical outcomes.

Rapid response systems (RRS, sometimes also termed medical emergency teams) are designed to intervene promptly on inpatients whose clinical condition is acutely deteriorating. Early RRS studies also demonstrated an additional role: evaluating the goals of care and potentially instituting "do-not resuscitate" (DNR) orders when appropriate. This analysis of data from a previous randomized trial of RRS found that such teams did in fact result in a significant increase in DNR orders compared to hospitals without RRS, although the magnitude of this effect was small (approximately 4 additional DNR orders per 10,000 admissions). Though widely implemented, RSS remain controversial due to conflicting evidence regarding their effectiveness on clinical outcomes. 

This study discovered that incomplete nursing documentation postoperatively was associated with night shifts and patients not receiving epidural or patient-controlled analgesia. Incomplete medical documentation was noted more commonly on the weekends.

This study discovered that patients receiving a medical emergency team (MET) assessment tended to be elderly and had a mortality rate exceeding 35%, with the highest rates in those where the MET response was delayed.

Delay in activating a medical emergency team was associated with adverse clinical outcomes in this Australian study.

Medical emergency teams (METs) are a widely implemented safety intervention, but controversy remains regarding their effectiveness. This study took place in Australia and New Zealand, where a prior randomized trial found no overall effect of METs on clinical outcomes. While most hospitals have implemented an MET, death rates from cardiac arrest appeared to decrease over the study period at all hospitals, regardless of whether an MET was in place. Despite the equivocal results of larger studies, implementation and development of METs will likely continue due to the improvement in clinical outcomes found in single-center studies and the positive opinion of nurses regarding the teams.

Delayed activation of the medical emergency team was associated with worsened patient outcomes, especially in patients with acute mental status changes.

The authors found that respiratory rate, heart rate, systolic blood pressure, and level of consciousness identified potential for cardiac arrest, unplanned intensive care unit admission, or unexpected death.

The authors present a case study of the use of a medical emergency team (MET) to manage a difficult airway in an elderly patient and the subsequent review of the incident by the clinical governance board.

This article defines the key components of a "rapid response system" (RRS), which the authors propose as a unifying term for medical emergency teams, rapid response teams, and other similar teams designed to intervene on clinically unstable inpatients. An RRS should consist of an "afferent limb," the mechanism by which team responses are triggered; an "efferent limb," the team of clinicians that responds to an event; an administrative arm responsible for team staffing, education, and implementation; and a quality improvement arm to assess effectiveness of the RRS and identify underlying quality of care issues. RRS effectiveness should be monitored by measuring mortality, cardiac arrests, and unplanned intensive care unit admissions. The authors did not endorse a specific model for the efferent limb, stating that physician-led or nurse-led models may both be appropriate depending on local circumstances. No consensus was reached on whether all hospitals should be mandated to institute an RRS.

This report from an Australian hospital with a well-developed medical emergency team (MET) describes the MET's intervention on two separate occasions for a patient with a hemorrhagic complication after a routine liver biopsy. The MET was initially called by the bedside nurse owing to abnormal vital signs, and subsequently by the surgical house officer because she was concerned about the patient. In this case, the MET conducted the initial resuscitation of the patient and was involved in coordinating care with multiple consulting physicians.