Failure to rescue—rapid response systems: A Making Healthcare Safer rapid review

Abstract

Background

Rapid response systems (RRSs) were developed to respond to early warnings of unexpected deterioration, but their effectiveness may be limited by factors impacting RRS activation (afferent limb) or response (efferent limb). Despite decades of RRS implementation, patients still experience unrecognized deterioration with associated worse outcomes.

Methods

This rapid review used modified search strategies to focus on the most valuable studies performed in the United States. Citations were screened by one reviewer with artificial intelligence as a second reviewer at the title/abstract review stage. The full text of eligible articles was then reviewed by a single team member to confirm eligibility. One reviewer completed the data abstraction, and a second reviewer checked the first reviewer's abstraction.

Results

Three categories of interventions were identified: implementation of a new RRS, and modifications to the afferent limb and/or efferent limb of an existing RRS. RRSs may have a large impact in reducing in-hospital mortality and an even greater impact in reducing cardiorespiratory arrest on hospital general wards in adults but the effect is unclear in children. Their impact on unanticipated intensive care unit admission is unclear. Modifications to the afferent and/or efferent limb were associated with a reduction in mortality and the incidence of cardiorespiratory arrest for adults.

Conclusions

RRS may have a large beneficial effect on hospital mortality and in-hospital cardiorespiratory arrest, but the strength of the evidence is low due to methodological weaknesses of the studies. Innovations in afferent and efferent limb structures show promise for increased benefit.