Rapid Response Systems

OVERVIEW

In Australia, a Rapid Response System (RRS) is a hospital-wide system to recognise and respond to the deteriorating patient is a requirement as set out in Standard 9 of the National Safety and Quality Healthcare Standards.

FEATURES

• Defines seriously ill patients, at-risk patients and patients whose condition is deteriorating using abnormal observations and vital signs (calling criteria)
• Provides rapid response to seriously ill patients and those whose condition is deteriorating
• Operates across the whole organisation
• Is designed around patient needs
• De-emphasises the usual hierarchies and inter-professional barriers
• Provides rapid consultation by experts in critical illness

COMPONENTS

• An afferent component to ensure timely escalation of the deteriorating patient, usually using agreed physiological values as triggers (e.g., the UK National Early Warning Score, or abnormal vital signs and / or lab values)
• An efferent component with an individual or team of clinicians who can promptly respond to deterioration (e.g., critical care outreach, medical emergency or rapid response teams)
• Governance and administrative structures to oversee and organise the service and its ways of working
• Analytic mechanisms to learn from good and poor practices and to improve processes of care

IMPLEMENTATION

Implementation of a RRS involves these steps:

• Engage all hospital staff and involve representation from all groups: hospital executive, senior nursing and medical, junior nursing and medical, allied health and ancillary staff and community representative
• Appoint “champions” from these groups to promote the system and to form the working party
• Review the literature and RRS models in other institutions and seek help from experts in the field
• Collect baseline data pre-implementation
• Determine appropriate RRS model for the hospital based on
  • Hospital case-mix
  • Hospital culture
  • Resources and funding
  • Pre-existing system e.g.: cardiac arrest team
• Issues to consider
  • Criteria for activation
  • Team composition
  • Home team involvement
  • ICU involvement
  • Projected number of calls
  • Consequent effects on existing services as staff take up these additional responsibilities & service provision
• Education of users of system hospital-wide
• Team training for MET personnel including clinical skills, communication, teamwork and end-of-life decision-making
• Source appropriate equipment / drugs for RRS calls and storage when not in use, with systems for checking & maintenance
• Establish system for data collection and audit
• Consider phased introduction of RRS or pilot project initially
• Data collection and audit from first day of implementation
• Review of data and benchmarking with other hospitals
• Feedback from RRS users and RRS team
• Modification of RRS as needed
• On-going education of staff and RRS team training
• Contribute to national database

RAMESH NAGAPPAN’S THREE RULES OF ICU OUTREACH

• Always help the patient
• Always teach something
• Always make the ICU look good

References and Links

FOAM and web resources

• Chalwin, Jones, Psirides, Radford. Managing Deteriorating Patients. 2018 [Free PDF download]
• NSQHS Standard 9: Recognising and Responding to Clinical Deterioration in Acute Health Care

Journal articles and books

• DeVita MA, Smith GB, Adam SK, et al. “Identifying the hospitalised patient in crisis”–a consensus conference on the afferent limb of rapid response systems. Resuscitation. 81(4):375-82. 2010. [pubmed]
• DeVita MA, Hillman K, Bellomo R. Textbook of Rapid Response Systems: Concept and Implementation. Springer, 2017 [google books]
• Hillman KM, Chen J, Jones D. Rapid response systems. Med J Aust. 201(9):519-521. 2014. [article]
• Jones DA, DeVita MA, Bellomo R. Rapid-response teams. The New England journal of medicine. 365(2):139-46. 2011. [pubmed]