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According to this survey of nursing leaders, they perceived that rapid response teams improve patient outcomes and safety culture. Evaluations of rapid response were usually informal and often did not capture standardized data. The authors advocate for future research to examine what different types of hospitals perceive as valuable in rapid response teams.

Early recognition of sepsis is a patient safety issue, due to the time-sensitive nature of delivering evidence-based treatments. This article describes a Centers for Medicare and Medicaid Services–funded initiative to improve sepsis management in 15 facilities in Texas. Components included convening a leadership committee for performance improvement, educating bedside nurses and other staff, developing a screening tool in the electronic health record (EHR), standardizing a second responder protocol (like a rapid response team) for possible sepsis, and conducting audit and feedback for participating institutions. The authors noted challenges given that participating institutions used different EHRs, but they were able to implement EHR-based screening across all systems. Positive screens were evaluated by a second responder, but it is difficult to estimate the amount of second responder time needed for this intervention. Planned outcome measures, which are not yet available, include mortality, length of stay, and costs. A recent WebM&M commentary describes common errors in the early management of sepsis.

This study describes the introduction of a rapid response system (RRS) on a high-risk obstetric unit at a large academic medical center. The number of RRS activations over the first 3 years has steadily increased, which the researchers consider a marker of successful RRS integration.

Despite widespread implementation of rapid response systems, they remain controversial. This study showed that delayed activation of rapid response was associated with worse morbidity and higher mortality compared to timely rapid response implementation. This work adds to recent data suggesting that rapid response improves patient safety.

This report of a quality improvement project to increase use of the rapid response team resulted in more frequent rapid response activation and a nonsignificant decrease in the number of code blue events occurring outside the intensive care unit. This intervention demonstrated staff behavior change, but its effect on patient outcomes remains unclear, adding to the mixed evidence about rapid response systems.

Although rapid response programs have been advocated as promising patient safety strategies, the evidence regarding their benefits is mixed. This review provides an overview of rapid response systems, including key components and goals of the intervention. Further research is needed to provide justification on their use for adult patients.

The introduction of a modified early warning system at a community academic medical center was associated with more rapid response team activations (from 0.24 to 0.48 per 100 patient-days), but fewer code blues and a decline in overall inpatient mortality (from 2.3% in 2011 to 1.5% in 2013).

Rapid response teams (RRTs) have been strongly endorsed by organizations including the Institute for Healthcare Improvement, largely based on early results that showed impressive benefits (although later studies were less positive). This study describes RRT programs in hospitals participating in a statewide collaborative that was established to help implement, evaluate, and sustain RRTs at acute care hospitals. Of the 56 hospitals in the collaborative, 31 hospitals responded to the survey, yielding a response rate of 55%. The authors describe the different organizational characteristics and RRT structures at these hospitals. Most of the teams included a critical care nurse and respiratory therapist. About 30% had a hospitalist and 23% reported the presence of a dedicated RRT nurse. Some best practices for safety, process improvement, and oversight were lacking in many of the programs. A prior AHRQ WebM&M perspective explored early lessons from RRTs.

Using case stories and direct quotes from frontline nurses, this study explores the barriers to appropriately activating rapid response teams. For example, the nurses in this study suggested that calling a rapid response is felt to only be justifiable in extreme situations rather than beforehand, which severely limits the potential effectiveness of this intervention.

Allowing families to activate medical emergency teams (METs) may aid in the early detection of clinical deterioration. However, physicians have expressed concerns that families do not understand when an MET is necessary and that this responsibility could present an undue stress on family members. This study reports on the experience of family-activated MET calls over a 6-year period at an academic children's hospital. There were 83 family-activated MET calls, representing less than 3% of all MET responses at this hospital. Families most frequently requested METs for concerns regarding clinical deterioration, but less than one-quarter of these calls resulted in patients being transferred to an intensive care unit, compared to 60% of clinician-activated METs. Since families called METs only between one to two times per month, the program was not felt to pose a substantial burden. The authors also point out that some family-activated METs identified other clinically relevant information that may not have otherwise been shared with the primary clinical team, as well as important communication issues that could have led to adverse events.

This before-and-after analysis revealed a decline in inpatient mortality following implementation of rapid response teams, but due to the overall trend of decreasing hospital mortality the authors could not definitively attribute this result to the rapid response team. This work demonstrates the ongoing challenge of assessing the effect of rapid response systems, which remain controversial.

Medical emergency teams (METs) have been widely implemented in hospitals, with some evidence suggesting that they may be effective at reducing serious clinical deteriorations. This study aimed to create a financial model to determine the potential benefits and costs of operating an MET at a children's hospital. Relying on various derived calculations, the authors estimate that the care of patients who experience a critical deterioration during hospitalization costs nearly $100,000 more following the event compared with other patients who transfer to an intensive care unit. The annual costs of operating an MET range widely, anywhere from $287,000 to $2.3 million, depending on who is staffed and whether the team has concurrent responsibilities or is freestanding. Under a bundled payment system—where a health system is paid a fixed reimbursement for a hospitalization—most MET team configurations would prove cost-effective if they successfully avoid a modest number of critical deteriorations each year. A prior AHRQ WebM&M perspective discusses early lessons of medical emergency teams.

This study reviewed medical emergency response team activations in a radiology department. Radiology accidents accounted for 10% of events. The majority of clinical deteriorations occurred within 48 hours of admission, often while the patient was undergoing imaging to help diagnose an unknown underlying illness.

This quality improvement initiative created a nurse-led rapid response team without additional staff costs. According to this study, a lower proportion of cardiac arrests occurred outside the intensive care unit (ICU) following implementation, but the concurrent addition of 26 ICU beds makes the finding difficult to interpret. The literature remains mixed regarding the benefits of rapid response teams.

Rapid response systems have been widely advocated as a means of averting adverse clinical outcomes for inpatients. This pre-post study examined the effectiveness of simulation training for rapid response teams. Although participants rated the training favorably, the increased use of rapid response teams did not improve mortality rates, similar to previous studies.

This commentary describes the design and implementation of a patient charting initiative based on principles from a surf lifesaving program in Australia. The intervention standardized documentation of patients' vital signs to create visual triggers for timely launch of a medical emergency team.

Approximately 8% of rapid response team calls at an academic medical center were for patients who were not hospitalized—primarily patients attending outpatient visits or undergoing outpatient procedures. The majority of these patients subsequently required hospital admission.

In an effort to provide more timely responses to clinical deteriorations, some pediatric medical centers have enabled family members to directly activate medical emergency teams (METs). This study used semistructured interviews to examine physicians' viewpoints on issues related to family-activated METs. Even though the majority of physicians said they depend on families to identify subtle changes in their child's condition, 93% of respondents reported that families should not be able to access the MET directly. Some concerns included families' lack of medical knowledge and training to determine when a MET is necessary, and the belief that this responsibility could provide an undue burden and stress on family members. These tensions are similar to prior discussions about other efforts to engage patients in their own safety during hospitalization.

Although effectiveness of rapid response teams has traditionally been measured by using rates of cardiac arrests or intensive care unit transfers, this study advocates for using the AHRQ failure to rescue metric instead. Failure to rescue rates declined in the second year after implementation of the rapid response team in concert with increased utilization of the team.

This study group created a standardized running sheet for documenting medical emergency team (MET) events at their medical center. About half of ward nurses felt that this tool improved patient handoffs to the arriving METs.