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Rapid-Response Teams
Abstract
Rapid-response teams aim to care for inpatients in whom acute respiratory, neurologic, or cardiac insufficiency is developing. This review describes the prevalence and consequences of sudden critical illness outside the ICU and discusses the rationale for rapid-response systems.
... In this section, we compare OppIN with Google Maps in terms of effectiveness in crisis navigation for specialized services based on defined comparison criteria. From the perspective of specialized service needs to ensure an efficient response in crisis events we defined the following criteria: [63]- [65]: 1) Precision: For specialized services, navigation systems precision is essential to guarantee precise location data and optimal routing. The OppIN system can achieve high precision by combining real-time data from IoT devices, specialized data sources (such as topographic maps, sensible zone locations, national geographic databases, etc.), and our fine-tuning algorithm that incorporates those insights for emergency response scenarios. ...
In this paper, we introduce the Optimal Path Intervention System (OppIN), a solution designed to support multiple emergency services, including fire response, civil protection, and emergency medical assistance, to reach crisis locations as quickly as possible by harnessing Big Data technologies and IoT infrastructure. OppIN computes quasi-real-time optimal intervention paths using a multi-criteria approach, incorporating both static factors (such as road network geometry, road conditions, and service locations) and dynamic data (including crisis locations captured by IoT sensors and real-time traffic conditions monitored through surveillance cameras). Using the IoT infrastructure and local data for quasi-real-time updates, OppIN adapts effectively to dynamic changes in context, ensuring the use of up-to-date information alongside Big Data technologies and AI for real-time processing. Compared to existing solutions such as Google Maps, our system uses a broader set of data sources and criteria, such as weather conditions, distance, traffic dynamics, and road status, to provide a more comprehensive and tailored analysis for specialized service navigation. Additionally, OppIN offers superior scalability and performance, using a Big Data-driven system design to handle high data volumes and real-time processing demands effectively. Furthermore, our system uses AI programs to estimate different criteria and to aggregate these criteria for quasi-real-time paths calculation.
... For more than two decades, the appropriate detection and management of clinical deterioration has been of key importance for quality, safe care provision within health services (DeVita et al. 2017). Early recognition and response to clinical deterioration are crucial in preventing serious adverse events such as unplanned intensive care unit (ICU) admissions, cardiac arrest, and even death (Jones et al. 2011). This has led to the development of physiological track-and-trigger systems (PTTSs) in hospitals to support nurses in the early recognition of clinical deterioration and guide the escalation of care decisions and clinical actions to prevent further deterioration (Gao et al. 2007). ...
Background
Nurse worry is a criterion often included in early warning systems tools and used to escalate care when other clinical markers do not indicate deterioration. What it means to worry, however, is not always clear.
Aims
To generate a concept analysis of nurse worry in relation to clinical deterioration.
Design
Rodgers's evolutionary method was used.
Method
A review was first conducted in April 2024, searching the Cumulative Index for Nursing and Allied Health Literature, Pubmed, EmCare, and Embase databases. A total of 22 articles were subjected to analysis of the antecedents, attributes, and consequences of nurse worry in the context of clinical deterioration. The processes of nurse worry were subsequently mapped and conceptualised, leading to a descriptive statement of nurse worry.
Results
Worry captures a nurse's sense of knowing the patient and is embodied via assessing, sensing, recognising, and processing information, cues, and patterns.
Conclusion
Nurse worry is a complex process, impacted by external and internal factors. Implications for the profession or patient care: Assured practice, driven by validation of a nurse's worry, leads to proactive care of the deteriorating patient, whereas apprehensive practice, driven by fear and trepidation, leads to reactive care of the deteriorating patient.
Impact
Nurse worry is a criterion often included in early warning systems tools and used to escalate care when other clinical markers do not indicate clinical deterioration. What it means to worry, however, is not always clear. From the concept analysis, a descriptive statement of nurse worry emerged. Worry captures a nurse's sense of knowing the patient and is embodied via assessing, sensing, recognising, and processing information, cues, and patterns.
Implications for the Profession or Patient Care
This research has implications for nurses, policymakers, and organisations, as nurse worry is an important element in detecting clinical deterioration. Nurse worry must be organisationally supported.
Reporting Methods
PRISMA Extension for Scoping Reviews (PRISMA‐SCR).
Patient or Public Contribution
No Patient or Public Contribution.
... Numerous surveillance systems have been developed for inpatients including continuous monitoring technologies 17,18 and early warning systems. [19][20][21] Such technologies and systems have had limited application for deterioration detection in outpatient cancer care [22][23][24][25][26] where low-tech solutions prevail (e.g., more frequent clinic visits, phone calls 27,28 ). Current approaches still largely rely on patients and/or caregivers to recognize early signs of deterioration and appropriately communicate this to the clinical system. ...
Background A common cause of preventable harm is the failure to detect and appropriately respond to clinical deterioration. Timely intervention is needed, particularly in medically complex patients, to mitigate the effects of adverse events, disease progression, and medical error. This challenging problem requires clinical surveillance, early recognition, timely notification of the appropriate clinicians, and effective intervention.
Objectives We determined the feasibility of designing, developing, and implementing the tools and processes to create a surveillance-and-risk prediction system to detect clinical deterioration in cancer outpatients.
Methods We used systems engineering and iterative human-centered design to develop a functional prototype of a surveillance-and-risk prediction system. The system includes passive surveillance involving wearable sensors, active surveillance involving patient event and symptom reporting as well as extraction of selected patient data from the electronic health record (EHR), a predictive model, and communication of estimated risk to clinicians. System usability was evaluated using patient and clinician interviews and clinician ratings using the System Usability Scale (SUS).
Results Fifty of 71 recruited patients enrolled in the feasibility study. Patient-reported outcome measures and clinical data extracted from the EHR were the best predictors of a patient's 7-day risk of experiencing unplanned treatment events (UTEs, i.e., emergency room visits, hospital admissions, or major treatment changes). Deep learning neural network models using these predictors demonstrated modest performance in predicting 7-day UTE risk (PROMS, F-measure: 0.900, area under the receiver operating characteristic curve [AUC-ROC]: 0.983; clinical data from EHR F-measure: 0.625, AUC-ROC: 0.983). Patient risk scores were communicated to clinicians using a risk communication prototype rated favorably by clinicians with a SUS score of 76 out of 100 (median = 80; range: 60–85).
Conclusion We demonstrate the feasibility of a surveillance-and-risk prediction system for detecting and reporting clinical deterioration in cancer outpatients. Future research is needed to fully implement and evaluate system adoption and effectiveness under different clinical situations.
This handbook provides a practical approach to the evaluation, differential diagnosis, and management of common medical and surgical emergencies such as cardiac arrest, acute respiratory failure, seizures, and hemorrhagic shock occurring in hospitalized patients. Less common and special circumstances such as pediatric, obstetric, oncologic, neurologic, and behavioral emergencies as well as palliative care for terminally ill patients encountered in the context of rapid response team (RRT) events are also discussed. An overview of commonly performed bedside emergency procedures by rapid response team members complements the clinical resources that may need to be brought to bear during the course of the rapid response team event. Finally, an overview of organization, leadership, communication, quality, and patient safety surrounding rapid response team events is provided. This book is written with medical students, junior physicians, and nursing staff in mind working in both academic and community hospital settings. Both a novice and an experienced healthcare provider involved in a rapid response system (RRS) will find this handbook to be a valuable supplement to the clinical experiences gained through active engagement in the system. Hospital administrators and senior management staff will also find this book to be useful in the evaluation of quality and performance of the rapid response system, management of staff attitudes and behavior, performance of peer review, care for second victims, and implementation of countermeasures for patient safety problems discovered in the course of rapid response system reviews.
This handbook provides a practical approach to the evaluation, differential diagnosis, and management of common medical and surgical emergencies such as cardiac arrest, acute respiratory failure, seizures, and hemorrhagic shock occurring in hospitalized patients. Less common and special circumstances such as pediatric, obstetric, oncologic, neurologic, and behavioral emergencies as well as palliative care for terminally ill patients encountered in the context of rapid response team (RRT) events are also discussed. An overview of commonly performed bedside emergency procedures by rapid response team members complements the clinical resources that may need to be brought to bear during the course of the rapid response team event. Finally, an overview of organization, leadership, communication, quality, and patient safety surrounding rapid response team events is provided. This book is written with medical students, junior physicians, and nursing staff in mind working in both academic and community hospital settings. Both a novice and an experienced healthcare provider involved in a rapid response system (RRS) will find this handbook to be a valuable supplement to the clinical experiences gained through active engagement in the system. Hospital administrators and senior management staff will also find this book to be useful in the evaluation of quality and performance of the rapid response system, management of staff attitudes and behavior, performance of peer review, care for second victims, and implementation of countermeasures for patient safety problems discovered in the course of rapid response system reviews.
This handbook provides a practical approach to the evaluation, differential diagnosis, and management of common medical and surgical emergencies such as cardiac arrest, acute respiratory failure, seizures, and hemorrhagic shock occurring in hospitalized patients. Less common and special circumstances such as pediatric, obstetric, oncologic, neurologic, and behavioral emergencies as well as palliative care for terminally ill patients encountered in the context of rapid response team (RRT) events are also discussed. An overview of commonly performed bedside emergency procedures by rapid response team members complements the clinical resources that may need to be brought to bear during the course of the rapid response team event. Finally, an overview of organization, leadership, communication, quality, and patient safety surrounding rapid response team events is provided. This book is written with medical students, junior physicians, and nursing staff in mind working in both academic and community hospital settings. Both a novice and an experienced healthcare provider involved in a rapid response system (RRS) will find this handbook to be a valuable supplement to the clinical experiences gained through active engagement in the system. Hospital administrators and senior management staff will also find this book to be useful in the evaluation of quality and performance of the rapid response system, management of staff attitudes and behavior, performance of peer review, care for second victims, and implementation of countermeasures for patient safety problems discovered in the course of rapid response system reviews.
The early detection of clinical deterioration in hospitalized patients is vital to improving outcomes, reducing mortality, and preventing unplanned intensive care unit (ICU) admissions. Nurses, as frontline providers, are uniquely positioned to identify subtle changes in patient conditions, often relying on a combination of clinical intuition, experience, and evidence-based tools. Historically rooted in observational skills and "gut feelings," the nurse’s role has evolved with advancements in standardized protocols and innovative technology, transforming intuition into measurable and actionable practice. This article examines how nurses bridge traditional bedside care with modern tools such as Early Warning Systems (EWS), electronic health record (EHR)-based alerts, and artificial intelligence (AI)-powered predictive analytics to identify early signs of clinical decline. Case studies and evidence demonstrate the effectiveness of nurse-led detection strategies in reducing mortality, improving resource utilization, and enhancing patient safety. Despite their critical role, nurses face challenges such as high workloads, inadequate training, and limited access to advanced technology. Addressing these barriers through education, technological integration, and systemic support is essential to optimizing early recognition efforts. By elevating nurses’ contributions, healthcare systems can ensure a proactive, data-driven approach to early clinical deterioration detection, ultimately transforming patient care and improving global healthcare outcomes.
Background: Residents and nurses who activate rapid response teams (RRTs) are well positioned to offer insights on its effectiveness. Here, we assess such evaluation of RRTs and identify barriers to activation in a 1,400-bed teaching hospital.Methods: We conducted a 24-item Likert-scale survey from January to May 2017 among residents and ward nurses with RRT experience. Factor analysis was used to identify the barriers.Results: This study comprised 305 nurses and 53 residents, most of whom were satisfied with their RRT experiences. Factor analysis showed that lack of awareness of activation criteria was a major barrier, with only 21.4% and 22.2% participants, respectively, confident about their knowledge of activation protocols. Of the survey respondents, 85.7% reported first contacting the doctor before activating the RRT. Despite the protocol, 66.7% first discussed the decision with other staff, and 71.5% called the RRT when the patient’s condition worsened despite management.Conclusions: Nurses and residents value RRTs but face barriers in initiation, primarily due to a lack of confidence in applying the activation criteria. Many prefer to consult a doctor or manage the patient before calling the RRT.
Implementing a MET response system in a hospital will likely alter the culture of care and threaten the status quo. There
are many potential psychological, emotional, sociological, and economic barriers to bringing a new system of care to a stable
environment. Nevertheless, strong data indicate that such a system of care will decrease unexpected mortality in a variety
of hospital settings. Therefore, the key question with which hospital leadership must grapple is how to implement the system,
not whether to implement it. There is no strong data to define the particular barriers, nor how to overcome them. Instead,
in this chapter we have proposed strategies that have been effective in our hospital environments and may benefit others as
well.
Early goal-directed therapy (EGDT) for severe sepsis and septic shock has been shown to significantly decrease 60 day mortality and survivor hospital length of stay [1]. However, concern exists over the additional resources and personnel required for this labor-intensive therapy.
To determine the frequency of monitoring of patient vital signs in two wards of a tertiary hospital.
A retrospective observational study of patient charts from two wards was conducted for a 48-hour period (Sunday and Monday, 23 and 24 October 2005). All vital sign readings from all patient charts were collected.
1597 unique vital signs were recorded in 62 patients. Frequency of documentation was significantly lower for respiratory rate than for all other vital sign measurements: respiratory rate, 1.0 reading/day, versus blood pressure, 5.0 readings/day; heart rate, 4.4 readings/ day; and temperature, 4.2 readings/day (P < 0.001 for all comparisons). Comparisons between blood pressure, heart rate and temperature frequency measurements showed no statistical differences, but there were significant differences in overall collection frequency between the medical and the surgical ward (3.0 v 5.0 readings/day, P < 0.001).
Blood pressure, heart rate and temperature were the most diligently recorded vital signs, but documentation of respiratory rate was poor. Failure to perform vital sign measurements may underpin the failure to recognise patients in general wards whose condition is deteriorating.
Current debate in the medical community centers on the benefits of rapid response teams (RRTs), hospital-based teams composed of clinicians with intensive care unit (ICU)–level clinical expertise. These teams rapidly respond when the condition of patients being cared for outside of the ICU suddenly deteriorates, and such patients often require transfer to ICUs.¹ Those on one side of the debate suggest that RRTs save lives; this assertion is supported by common sense, numerous anecdotal reports, and some observational studies.² Those on the other side of the debate suggest that preventing, recognizing, and treating deteriorating patients is common sense. How best to achieve this remains elusive based on systematic reviews,³ which have failed to show benefit of RRTs but note that RRT studies were often of poor quality and clinicians often failed to call an RRT when they should have, leading to uncertainty in the estimates of benefit. Proponents favor further research, encouraging hospitals to experiment with strategies such as RRTs, enhanced nurse staffing, or hospitalists who would respond to deteriorating patients, stressing prevention rather than recovery from deterioration. Those on both sides of the debate are united in their frustration that patients are needlessly experiencing morbidity and agree that preventing patients' health from deteriorating is the optimal solution.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
(1) To determine the effectiveness of outreach services on ICU admission patterns of adult patients who deteriorate on general wards.
(2) To determine the impact of outreach services on hospital mortality rates and length of hospital stay.
(3) To identify within included studies adverse events (unexpected cardiac or respiratory arrest) and death in hospital before and after the introduction of outreach services.
A review of the medical records of over 14 000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an “adverse event”, which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.
Objective
To investigate the nature and duration of clinical instability (ie, abnormalities in simple physical observations or laboratory test results) in hospital patients before a “critical event” (ie, a cardiac arrest or an unplanned admission to intensive care).
Design
Retrospective survey of medical records of all patients having critical events (CEs) over 12 months. Data on hospital and Intensive Care Unit (ICU) patients were obtained for comparison with the study population.
Setting
A 300‐bed metropolitan teaching hospital with a seven‐bed ICU.
Patients
All patients having CEs over a 12‐month period (January to December 1997).
Main outcome measures
Number of patients with clinical instability before a CE; duration of clinical instability before a CE; number of medical reviews of each patient before a CE; mortality rate and length of hospital stay for all patients.
Results
There were 122 CEs in 112 patients (median, 1; range, 1–4). Of the CEs, 79 were unplanned ICU admissions (14 subsequent to cardiac arrest calls), and 43 were cardiac arrest calls not resulting in ICU admission. Each CE was preceded by a median of two (range, 0–9) criteria for clinical instability. The median duration of instability before a CE was 6.5 hours (range, 0–432 hours), and in that time a median of two (range, 0–13) medical reviews took place. The incidence of CEs in the total hospital population (122 CEs/19853 admissions) and in ICU patients (79 unplanned admissions/515 admissions) was 0.6% and 15%, respectively. There were 70 deaths (62%) among the 112 patients, compared with a total of 392 deaths (2% of admissions) in the hospital, of which 107 were in ICU.
Conclusions
Very few patients suffer a CE while in hospital. However, those who do frequently manifest abnormalities in simple physical observations and laboratory test results before the CE. More rapid intervention in response to warning signs might provide a better outcome for these patients.
The occurrence of hospital-induced complications on a university medical service was documented in the prospective investigation of over 1000 patients. The reported episodes were the untoward consequences of acceptable medical care in diagnosis and therapy. During the 8-month study, 240 episodes occurred in 198 patients. In 105 patients, hospitalization was either prolonged by an adverse episode or the manifestations were not yet resolved at time of discharge. Thus, 20% of the patients admitted to the medical wards experienced one or more untoward episodes and 10% had a prolonged or unresolved episode. The severity of the 240 episodes was minor in 110, moderate in 82, and major in 48, of which 16 ended fatally. Patients encountering noxious episodes had a mean total hospitalization of 28.7 days compared with 11.4 days in other patients. The risk of having such episodes seemed directly related to the length of time spent in the hospital. The number and variety of these reactions emphasizes the magnitude and scope of hazards to which the hospitalized patient is exposed. A judicious selection of diagnostic and therapeutic measures can be made only with knowledge of these potential hazards as well as the proposed benefits.