Rapid Response Systems
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.
- 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
- 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 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]
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
great overview. We (Daryl Jones, Rick Chalwin, Alex Psirides and Myself plus many co-authors) have put together a FOAM resource that may be desirable for LIFTL readers and clinicians who attend rapid response calls.
It is designed to be easy to read on our various devices in pdf form
Feel free to encourage downloads of the whole book.