Advances in performance, more benefits... the perspectives of rapid response teams

Rapid response teams (RRT) emerged in 1990 with the goals of improving the identification of ward patients with clinical deterioration and offering, based on this identification, early intervention.(1-3) An RRT is activated according to previously defined triggers, traditionally vital signs, by themselves or as part of aggregated scores, other clinical changes, such as seizures, or even by a subjective criterion of concern about a patient. Once activated, the RRT evaluates the patient within five minutes, preferably, and defines the required procedures, such as fluid administration, antibiotic initiation, ventilatory support, and transfer to the intensive care unit (ICU). The presence of RRT in hospitals has been strongly suggested by organizations such as the Joint Commission and Institute for Healthcare Improvement.(4,5) This suggestion is based on the possible benefit of providing early critical care to patients with deterioration, combined with evidence from “before and after” studies of cardiac arrest reduction.(1,6) With the wide spread of rapid response systems, a constant increase has been observed in publications related to multiple elements of this model.(1) Recently, other potential benefits, in addition to strategies to improve the performance of RRT, have been described. In this edition of the Revista Brasileira de Terapia Intensiva, Mezzaroba et al. present a retrospective cohort study on the implementation of RRTs led by intensivists in university hospitals.(7) Although the RRT performance in this study has been restricted to 12 daytime hours, the initiative has produced the following quality criteria:(8) the “dose” delivered by the RRT was 102 calls per 1,000 admissions in the first year, with a median of two minutes for the arrival of the RRT at the bedside. Even with the decline in the number of calls in the following years, the “dose” was still well above the recommended minimum rate (25 per 1,000).(9) Although the authors highlight the risk factors for hospital mortality, the performance characteristics of the RRT itself are the most relevant data. The subjective criteria of concern about the patient was the main trigger used to activate the RRT, reinforcing its importance in increasing the low sensitivity of objective criteria.(10,11) In addition, the RRT had, among its responsibilities, to visit critical patients who remained in the ward daily. This is consistent with broader RRT activity, which has been suggested to include, for example, proactive visits and follow-up of patients discharged from the ICU.(12,13) The retrospective design and the decrease in the number of calls are possible limitations of this study. The authors describe that the decrease in calls may be due to the implementation of daily visits; however, it is very likely that professional and/or cultural barriers have contributed. Marcio Manozzo Boniatti1