Family Members’ Perspective
It is difficult to be certain about the bedside physician’s psychological investment in METs or RRTs when they were first introduced. Many expressed that they had the skills to deal with most situations, and that the teams were redundant. They did acknowledge that there were times when they were not available, but seemed to think that those times were rare. At the same time, critical care physicians often felt that having to leave the ICU to take care of “non-ICU” patients was a burden on them, and strained their ability to deliver care in the ICU. This one-two-punch of hospitalists not wanting any outside intrusion, and intensivists not wanting any new burdens, led to a culture opposed to the system.
On the other hand, those involved in quality work recognized that respiratory and cardiac arrest events were often preceded by periods of deterioration that were not recognized or treated.
In the UK and North America, nurses were most commonly involved in the response teams, calling on physicians to help when necessary. Australia on the other hand, had critical care physicians leading teams. After a time, with many case reports of dramatic improvements, and enthusiastic family and nurse support, governmental and regulatory agencies promoted or required some sort of rapid response system to prevent unnecessary hospital deaths. Such mandates occurred in the absence of randomized controlled trials clearly supporting the intervention. Years later, the culture has changed, with most intensivists recognizing that critical care should not be constrained by “location,” but rather should be brought to bear wherever the service is needed. Hospitalists have embraced the system as well, either as responders or by actively utilizing RRS support for their patients who become suddenly critically ill outside the ICU.
While the overall goal of Rapid Response Systems (RRS) is to prevent unexpected clinical complications and mortality for hospitalized patients, in many settings these programs do so by providing direct assistance, support, and leadership opportunities for bedside nurses. RRS are designed to identify patients in clinical crisis, request and receive assistance from expert healthcare providers, coordinate necessary clinical resources, and provide follow-up with the bedside staff. Through the designation of common symptoms of clinical deterioration, busy bedside nurses are better able to recognize patients in need of early interventions and clearly communicate the need for urgent clinical support. Expert providers are then coordinated through the RRS to address the clinical needs of the patient, while supporting the clinical care provided by the bedside nurse. Patients receiving RRS interventions frequently require transfers to higher levels of care, which can be a prolonged and cumbersome process. RRS policies and procedures are often designed to help alleviate these challenges and facilitate the ability to emergently transfer patients. In addition, RRS teams in smaller facilities may be coordinated by expert ICU nurses these teams provide a pathway for leadership opportunities and clinical growth.