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Review
. 2018 Jul:128:191-197.
doi: 10.1016/j.resuscitation.2018.05.013. Epub 2018 May 16.

Rapid response systems

Patrick G Lyons  1 , Dana P Edelson  2 , Matthew M Churpek  3
Affiliations
Review

Rapid response systems

Patrick G Lyons et al. Resuscitation. 2018 Jul.

Abstract

Introduction: Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems.

Aims: We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation.

Data sources: Articles written in English and published in PubMed.

Results: Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement.

Conclusions: Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors.

Keywords: Medical emergency teams; Rapid response systems; Rapid response teams.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: Dr. Lyons is supported by a T32 grant (5T32 HL007317). Dr. Churpek is supported by a career development award from the NHLBI (K08 HL121080), an R01 from NIGMS (R01 GM123193), and has received honoraria from Chest for invited speaking engagements. Drs. Churpek and Edelson have a patent pending (ARCD. P0535US.P2) for risk stratification algorithms for hospitalized patients. In addition, Dr. Edelson has received research support from Philips Healthcare (Andover, MA), research support from the American Heart Association (Dallas, TX) and Laerdal Medical (Stavanger, Norway), and research support from EarlySense (Tel Aviv, Israel). She has ownership interest in Quant HC (Chicago, IL), which is developing products for risk stratification of hospitalized patients.

Figures

Figure 1
Figure 1
See this image and copyright information in PMC

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