Rapid response systems (RRS) have been developed to proactively identify patients at risk for clinical deterioration within the hospital, and to deliver reliable, safe, quality treatment to those individuals. The RRS expands care for the critically ill across the whole hospital. The RRS has arisen in response to the widespread realisation that many patients suffer harm or death due to unrecognised or poorly managed deterioration – particularly in general wards – and is now well established or standard of care in many countries.
The Rapid Response System can be divided into
- 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.
The functions of a Rapid Response System include
- Identification of at-risk and deteriorating patients – and of patients that are dying (to ensure they are not subjected to inappropriately aggressive treatments).
- Support for ward staff caring for at-risk patients and those recovering from critical illness.
- Referral pathways for obtaining timely, effective critical care treatments.
- Immediate availability of expert critical care and resuscitation skills when required.
- Facilitation of timely transfer to a critical care facility when needed.
- Education for ward staff in recognition of fundamental signs of deterioration, and in understanding how to obtain appropriate help promptly.
- Outpatient support to patients and their families following discharge from hospital.
- Development of systems of coordinated, collaborative, continuous care of critically ill and recovering patients throughout the hospital – working across all silos and disciplines – and also in the community.
- Audit and improvement of basic standards of acute and critical care to optimise treatment of the critically ill throughout the hospital.