Rapid Response Systems 20 Years Later: New Approaches, Old Challenges

In 1990, Schein and colleagues changed the paradigm of in-hospital cardiopulmonary arrest. Their report, “Clinical Antecedents to In-Hospital Cardiopulmonary Arrest,” provided evidence from adults suggesting that many arrests could have been prevented if existing signs of deterioration were identified, interpreted, communicated, and responded to appropriately.1 Five years later, Liverpool Hospital published the first report of a rapid response system.2 This marked the start of a patient safety movement that spread quickly to children’s hospitals.3 Rapid response systems aim to improve the detection and management of deterioration in hospitalized patients. They combine tools to help clinicians identify deterioration with medical emergency teams that can be summoned to the bedsides of ill patients. Rapid response system implementation was associated with reductions in cardiopulmonary arrests (relative risk [RR], 0.62 [95% CI, 0.46-0.84]) and mortality (RR, 0.79 [95%CI,0.63-0.98]) in a recentmeta-analysis,4 and reversed a trend of increasing critical deterioration events (a more proximate outcome) in a quasi-experimental study.5Duein part tomountingevidence,commonsense appeal, and their inclusion in major initiatives like the Institute for Healthcare Improvement’s 5 Million Lives Campaign, rapid response systems are now nearly universally present in hospitals worldwide. Unfortunately, rapid responsesystemshavenotfully solved the problem they targeted 20years ago, and, despite progress, the challenges in pediatrics remain complex. Children still deteriorate on hospital wards, and 40% or more of these events may be preventable.6 There is an opportunity to renew the enthusiasm that surrounded the first generation of rapid response systemwork, which focused primarilyonthe medicalemergency team response, to pursue the more difficultwork of optimizing the identification of deteriorating children. Below we propose a set of recommendations for a research agenda aimed at addressing this challenge. [Introduction]