Rapid Response Teams were introduced globally in the 90s, and are now considered standard of care in hospitals across the USA.

They have been embedded in US hospitals beginning in 2004, since the 100,000 Lives Campaign was sponsored by the Institute for Healthcare Improvement. RRTs also provided hospitals the opportunity to meet a Joint Commission requirement that allows all staff members to obtain help from experts when their patient’s condition is worsening.

Overview of RRTs

Rapid Response Teams (RRTs) are multidisciplinary groups of healthcare professionals specifically organized to respond quickly to patients who are exhibiting signs of clinical deterioration in non-intensive care settings, such as general hospital floors. The primary objective of RRTs is to prevent Failure to Rescue (FTR) situations such as cardiac arrest, respiratory failure, or unanticipated transfers to intensive care units (ICUs).

Key points about RRTs include:

• Composition: An RRT typically consists of a critical care nurse, a respiratory therapist, and a physician or advanced practice provider with expertise in critical care. The exact composition can vary among institutions.
• Activation Criteria: Hospitals set specific criteria for activating the RRT. These might include changes in vital signs, acute changes in respiratory status, or concerns expressed by the nursing staff or the patient’s family.
• Function: Once activated, the RRT quickly assesses the patient’s condition, provides immediate treatment, and determines the best location for ongoing care, which may involve transferring the patient to a higher level of care, like the ICU.
• Benefits: The implementation of RRTs is associated with reductions in in-hospital cardiac arrests, decreased ICU transfer times, and improved patient outcomes.
• Patient Safety: RRTs are considered an essential component of patient safety initiatives in many hospitals. Their prompt intervention can prevent adverse events and complications.
• Education and Training: Part of the role of RRTs is also to educate other healthcare staff about the signs of clinical deterioration and the importance of early intervention. Guiding principle with activating a RRT is…when in doubt, call the RRT.

In essence, RRTs act as a “safety net,” ensuring that patients in non-intensive settings receive timely intervention if their clinical condition begins to worsen.

History of RRTs:

• When: The concept of RRTs started to gain traction in the early 2000s, particularly after several studies and initiatives highlighted the potential of early interventions to reduce hospital mortality rates.
• Where: The implementation of RRTs began in Australia and the United States, and the concept has since spread to many other countries. It’s important to note that while the underlying concept remains consistent, the specifics of how RRTs operate might vary from one institution to another based on resources, staff training, and local protocols.
• Why: The primary motivation behind implementing RRTs was to prevent Failure to Rescue events such as: cardiac arrests, sepsis or unplanned admissions to intensive care units. Signs and symptoms of early deterioration might be observed hours or even days before the adverse event. However, they can easily be missed due to a patient slowly changing. By establishing a team specifically trained to recognize and respond to  early warning signs, hospitals aimed to:
  • Improve patient outcomes by preventing avoidable adverse events.
  • Reduce the need for more expensive and resource-intense higher levels of care.
  • Enhance the safety culture within the hospital.
  • Provide support and education to nursing staff, enhancing their skills and confidence in managing deteriorating patients.

How RRTs work

Rapid Response Teams (RRTs) are activated by RNs’ that have discovered specific changes in a patient’s clinical status. These changes are considered key parameters that signal the patient is becoming unstable. 

While the specific criteria can vary from one institution to another, some common parameters include:

• Vital Signs:

  • Heart rate: Either too high (tachycardia) or too low (bradycardia)
  • Blood pressure: Either too high (hypertension) or too low (hypotension)
  • Respiratory rate: Either too fast (tachypnea) or too slow (bradypnea)
  • Oxygen saturation (SpO2): Low saturation and the need to add supplemental oxygen.
  • Temperature: Extremely high (hyperthermia) or low (hypothermia)

• Changes in Level of Consciousness:

  • New confusion, agitation, drowsiness, or unresponsiveness

• Respiratory Distress:

  • Signs of labored breathing, use of accessory muscles, new onset of wheezing or stridor and or new pallor.

• Seizures:

  • New onset of seizure activity.

• Concerning Laboratory Values:

  • Such as a significant drop in hemoglobin, elevated lactate, or abnormal electrolytes that might indicate an acute medical issue

• Urine Output:

  • Decreased urine output for a specific period (e.g., <0.5 ml/kg/hr for 2 hours in adults)

• Pain:

  • New severe pain or sudden onset of pain

• Staff Concerns:

  • A subjective feeling or “gut instinct” from a nurse, doctor, or other healthcare professional that something is not right with the patient, even if specific vital sign abnormalities are not present.

Many hospitals use an Early Warning Score (EWS) or Modified Early Warning Score (MEWS) system, which assigns points based on various physiological parameters. If the total score reaches a certain threshold, it can trigger a review by the RRT.

It’s worth noting that while these parameters provide guidelines, clinical judgment remains crucial. Sometimes, even if the parameters don’t strictly meet the set criteria, an RRT might be called based on the overall clinical picture and concerns of the healthcare team.

Challenges Affecting RRTs:

Rapid Response Teams (RRTs) have emerged as pillars of strength within healthcare systems since their initiation in the 1990s in Australia to worldwide adoption today.    RRTs now operate universally, stepping in with precision and skill during medical emergencies (Jones et al., 2011). Yet, for all their adoption and successes, RRTs face significant systemic challenges that require introspection and tailored solutions.

1. Lack of Standardization: Hospital-to-hospital variations in RRT structure, training, and methodologies present challenges. Without a universal standard, assessing the overall effectiveness and efficiency of these teams becomes difficult. Adopting uniform protocols would not only streamline performance evaluations but also guarantee equivalent care quality across institutions (Winters et al., 2013).
2. Expertise and Training Gaps: The caliber of RRTs fundamentally lies in the expertise and training of its team members. Unfortunately, many hospitals grapple with retaining seasoned experts, impacting both response times and care quality. Designing specialized training modules that encourage simulation based team training (SBTT) encourages teamwork and has show to uplevel overall performance .(Colman et al., 2019).
3. Improper Utilization: RRT’s can be misused if complex patients are automatically transferred to the ICU because they are part of a “busy assignment”, and not actually showing signs of deterioration.
4. Integration Roadblocks with Other Healthcare Teams: Optimal patient outcomes necessitate harmonious integration of RRTs with other healthcare stakeholders. Regrettably, communication obstacles often hinder this cohesion. Fostering an environment of transparent communication and inter-departmental collaborations can bridge these gaps (Manojlovich et al., 2015).
5. Data Utilization: The contemporary medical landscape is data-driven. RRTs, given their operations, are poised to harness this data for refining their methodologies. A robust data analytics infrastructure is essential to tap into this potential goldmine of insights. 

RRT Success Stories:

Amid these challenges, RRTs have produced an array of accomplishments:

• Cardiac Arrest Reduction: A significant drop in cardiopulmonary arrests outside ICUs underscores the effectiveness of RRTs in early identification and intervention (Chan et al., 2008).
• Mortality Rate Drops: RRTs have contributed to reducing hospital mortality rates, a testament to their proactive interventions (Winters et al., 2013).
• Elevated Staff Confidence: The mere presence of an RRT amplifies the confidence and spirit of healthcare personnel, fostering a supportive work environment (Bagshaw et al., 2010).
• Refined Clinical Decision Making: The multidisciplinary nature of RRTs has enriched clinical decision-making processes, ensuring that patients receive comprehensive care (Devita et al., 2010).
• Safety Culture Proliferation: RRTs symbolize a commitment to patient safety, advocating for a proactive approach to clinical risk management (Cretikos et al., 2007).
• Resource Maximization: RRT interventions have led to efficient healthcare resource utilization, evidenced by reduced ICU admissions and shorter hospital stays (Bellomo et al., 2004).
• Standardized Protocols Evolve: The growth trajectory of RRTs has sparked the development of standardized training protocols, promising consistency in patient care delivery (Jones et al., 2011).

In Conclusion:

Rapid Response Teams stand at the crossroads of traditional healthcare and modern medical innovations. While they’ve transformed emergency care paradigms, there is still untapped potential waiting to be explored.   

CalmWave ingests vital sign signals and data from the EMR to provide insights that help bedside staff make more informed decisions.   Leveraging Transparent AI, CalmWave is able to provide intelligent, real-time solutions that can help support initiatives around more automated, more comprehensive, and more intelligent, rapid response.  Schedule a demo to see how it works.

References:

• Jones, D., et al. (2011). Rapid Response Teams, N Engl J Med 2011;365:139-46.
• Winters, B. D., et al. (2013). Rapid-response systems as a patient safety strategy. Annals of Internal Medicine, 158(5_Part_2), 417-425.
• Manojlovich, M., et al. (2015). The interplay between teamwork, clinicians’ emotional exhaustion, and clinician-rated patient safety: a longitudinal study. Critical Care, 19(1), 110.
• Wu AW, Shapiro J, Harrison R, Scott SD, Connors C, Kenney L, Vanhaecht K. The Impact of Adverse Events on Clinicians: What’s in a Name? J Patient Saf. 2020 Mar;16(1):65-72

• Chan, P. S., Jain, R., Nallmothu, B. K., Berg, R. A., & Sasson, C. (2008). Rapid response teams: a systematic review and meta-analysis. Archives of internal medicine, 168(1), 18-26.
• Bagshaw, S. M., Mondor, E. E., Scouten, C., Montgomery, C., Slater-MacLean, L., Jones, D. A., … & Gibney, R. T. (2010). A survey of nurses’ beliefs about the medical emergency team system in a Canadian tertiary hospital. American journal of critical care, 19(1), 74-83.
• Devita, M. A., Bellomo, R., Hillman, K., Kellum, J., Rotondi, A., Teres, D., … & Auerbach, A. (2010). Findings of the first consensus conference on medical emergency teams. Critical care medicine, 34(9), 2463-2478.
• Cretikos, M., Chen, J., Hillman, K., Bellomo, R., Finfer, S., & Flabouris, A. (2007). The objective medical emergency team activation criteria: a case–control study. Resuscitation, 73(1), 62-72.
• Bellomo, R., Goldsmith, D., Uchino, S., Buckmaster, J., Hart, G. K., Opdam, H., … & Gutteridge, G. (2004). Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Critical care medicine, 32(4), 916-921.
• Colman N, Patera A, Hebbar KB. Promoting Teamwork for Rapid Response Teams Through Simulation Training. J Contin Educ Nurs. 2019 Nov 1;50(11):523-528.