The Rapid Response System (RRS) is a relatively unique intervention built around the needs of patients, and that needs to work across the whole organisation. The patient in this case is one who is deteriorating, usually on the general floor of an acute hospital. Specific aspects of these relatively new systems are the implementation of means for detecting the deteriorating patient amongst others who are progressing, creation of teams and other response units, and means to summon them. More mature systems also include means of evaluating their effectiveness and adapting it to patient needs. The challenges involved with implementing such a system is not as straight forward as implementing a new drug or procedure. It is a complex intervention and one that our hospitals have had little experience with before.
We tend to work within our own professional and geographical silos in hospitals. This is the strength of the way our hospitals operate. The patient is usually placed in a specialised ward such as medical or surgical with staff experienced in those particular specialties. But what happens if, for example, you have a retroperitoneal haemorrhage in a cardiac ward or pulmonary oedema in a surgical ward? You may not have staff with appropriate skills and experience to recognise and manage such unexpected complications outside their area of expertise.
Rapid response systems are built around simple calling criteria, which are typically significant deviations in vital signs and other measurements made in every hospitalised patient; examples are very high or low pulse and respiratory rates, blood pressure and so forth. Such deviations are common antecedents to major complications. When a rapid response system is implemented, development of such criteria leads to action. A team with appropriate skills, knowledge and experience is immediately called.
This is a similar process to any consultation from one specialist to another when confronted with clinical issues beyond their own level of expertise. However, when the patient has a potentially life-threatening complication, a quicker recognition and response is essential.
Interestingly, the culture of the organisation will affect the effectiveness of a RRS. Unless the whole hospital supports it mission, it may not work effectively. For example, empowering nursing staff to be advocates for their patients by actively encouraging them to call for a rapid response, even if the patient has not hit the criteria – the so-called worried or concerned criteria – can be threatening for both the nurse and doctor. In theory, this should not be the case. Doctors have always been encouraged to take into account the appearance of a patient when determining potential serious illness. Experienced nurses also have this ability. However, prior to the implementation of RRSs, nurses were not encouraged to use their experience and intuition. The lack of proper care for deteriorating patients was often a result of historically rigid systems not built around the needs of patients.
The culture of the organisation and readiness for change can influence the uptake of the RRS. Similarly, the implementation of a RRS can influence the culture of the organisation. As a result of the system, bedside nursing staff and junior doctors feel comfortable and empowered about initiating a summons for help when they have concerns about their patient. This has been a recent development in medicine, and is not the case in every country or hospital culture. The implementation of a RRS encourages a culture of patient safety. Staff are allowed to acknowledge that seriously ill patients exist in hospitals, and that they are able to advocate for their patient at any time. Many bedside clinicians feel that for the first time they work in a hospital that cares for patients 24/7.