Patrick G Lyons1, Dana P Edelson2, Matthew M Churpek3. 1. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, United States. 2. Department of Medicine, University of Chicago, Chicago, IL, United States. 3. Department of Medicine, University of Chicago, Chicago, IL, United States. Electronic address: matthew.churpek@uchospitals.edu.
Abstract
INTRODUCTION: Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. AIMS: We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation. DATA SOURCES: Articles written in English and published in PubMed. RESULTS: Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement. CONCLUSIONS: Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors.
INTRODUCTION: Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. AIMS: We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation. DATA SOURCES: Articles written in English and published in PubMed. RESULTS: Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement. CONCLUSIONS: Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors.
Authors: Gary B Smith; David R Prytherch; Paul E Schmidt; Peter I Featherstone; Bernie Higgins Journal: Resuscitation Date: 2008-07-11 Impact factor: 5.262
Authors: Samuel L Volchenboum; Anoop Mayampurath; Gözde Göksu-Gürsoy; Dana P Edelson; Michael D Howell; Matthew M Churpek Journal: JAMA Date: 2016-12-27 Impact factor: 56.272
Authors: Patricia Kipnis; Benjamin J Turk; David A Wulf; Juan Carlos LaGuardia; Vincent Liu; Matthew M Churpek; Santiago Romero-Brufau; Gabriel J Escobar Journal: J Biomed Inform Date: 2016-09-20 Impact factor: 6.317
Authors: Andrew M Namen; Daniel Forest; Amit K Saha; Kang Rui Xiang; Kelly Younger; Sheila Maurer; Zeeshan Ahmad; Arjun B Chatterjee; Cormac O'Donovan; Alexander Sy; Stephen P Peters; Edward F Haponik Journal: J Clin Sleep Med Date: 2022-08-01 Impact factor: 4.324
Authors: Zfania Tom Korach; Jie Yang; Sarah Collins Rossetti; Kenrick D Cato; Min-Jeoung Kang; Christopher Knaplund; Kumiko O Schnock; Jose P Garcia; Haomiao Jia; Jessica M Schwartz; Li Zhou Journal: Int J Med Inform Date: 2019-12-14 Impact factor: 4.046
Authors: Shannon M Fernando; Alison E Fox-Robichaud; Bram Rochwerg; Pierre Cardinal; Andrew J E Seely; Jeffrey J Perry; Daniel I McIsaac; Alexandre Tran; Steven Skitch; Benjamin Tam; Michael Hickey; Peter M Reardon; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Date: 2019-02-21 Impact factor: 9.097
Authors: Maj Juhl Skov; Jacob Dynesen; Marie K Jessen; Janet Yde Liesanth; Julie Mackenhauer; Hans Kirkegaard Journal: Scand J Trauma Resusc Emerg Med Date: 2020-04-10 Impact factor: 2.953
Authors: Marcello Covino; Giuseppe De Matteis; Maria Livia Burzo; Michele Santoro; Mariella Fuorlo; Luca Sabia; Claudio Sandroni; Antonio Gasbarrini; Francesco Franceschi; Giovanni Gambassi Journal: Intern Med J Date: 2020-12 Impact factor: 2.611