The Joint Commission Journal on Quality and Patient Safety: Rapid Response Systems: The Stories

Several studies have shown that patients frequently display physical evidence of deterioration as much as 8–12 hours before a cardiac arrest or critical event requiring some form of intensive intervention or rescue. Early recognition of these signs, followed by prompt treatment, may reduce death rates in hospitalized patients. However, deterioration is frequently difficult to assess because of the complex nature of patient care and the need for accurate evaluation skills. To identify patients at risk more reliably, some hospitals have pioneered the use of an automated risk assessment based on key physiologic measures. In some studies, rapid response teams (RRTs, also known as medical emergency teams [METs]) have been successful in the afferent components of rapid response systems—“event recognition and response trigger”—in both recognizing the early signs of patient deterioration and providing the appropriate clinical interventions to help patients. The typical triggers for calling an RRT are based on a set of physiologic parameters (Table 1, right). If any one of these values falls outside the specified parameters, the RRT is called for an evaluation. This type of system, sometimes called a single parameter risk assessment system, encourages the nursing staff to feel comfortable calling for assistance. Although a single-parameter approach has been effective, some hospitals, especially in the United Kingdom, have pioneered systems that respond to multiple parameters at the same time and identify at-risk patients at the first sign of a subtle change in vital signs. These so-called early warning scoring systems use weighted scoring of several parameters, in which the score is determined on the basis of the sum of the measures for each physiologic parameter. Determining a composite score involves assigning a number to each vital sign (Table 2, page 570)—there are typically between five and seven physiologic parameters. A predetermined normal range is assigned a 0, and increasing or decreasing points up to a maximum of 3 or 4 or a minimum of –3 are awarded to increasingly abnormal values. For example, using the example in Table 2, if a patient’s systolic blood pressure is Rapid Response Systems: The Stories