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Rapid Response Systems: How to Do It and Where Are the Benefits?

The care of in-hospital patients has substantially increased in complexity. Fragile inpatients are at risk for unanticipated clinical deterioration resulting in unplanned admission to the intensive care unit, cardiac arrest, and death. Although these deteriorations are perceived as sudden, observational studies establish that many events are preceded by recognizable warning signs. Rapid response systems (RRS) evolved from the perception that death from foreseeable cardiopulmonary deterioration is potentially preventable. These systems are designed to educate general inpatient unit staff to recognize early warning signs and symptoms and then mobilize personnel with the knowledge, skills, experience, and equipment to intervene and prevent deterioration toward cardiac arrest and death. However, translating common sense into evidence for a complex intervention like RRS poses enormous challenges. This review summarizes the infrastructure necessary to achieve a successful RRS and the obstacles encountered by each component. Published studies of RRS are reviewed, including limitations and criticisms that may explain variable success rates for the intervention. Finally, the motivation for implementation of such a system is explored given the context of ongoing controversy.