Early Warning Signs and Rapid Response on the Nursing Floor—Can We Do More?

Abstract

Beginning 1989 to 1994 in Sydney, Australia, Lee et al first described a novel model to improve care of a clinically deteriorating floor patient by bringing a highly skilled team of experts to the bedside. The primary goal of this medical emergency team was to prevent the patient from advancing their morbidity, and reducing their mortality. This system established the conceptual framework for what would expand into the rapid response system (RRS) model of care over the next decade. Conflicting information has since been published as to the exact impact that RRSs have achieved. Several observational studies have shown a decrease in code rates in patients outside of the intensive care unit (ICU), whereas other randomized single-center trials have found no significant outcome benefit. Although the concept of an RRS to recognize patient deterioration to improve patient outcome is intuitive, it has been difficult to substantiate objectively. Despite limitations, use of a RRS remains an ubiquitous and important care model for the hospitalized patient. By 2009, ~1800 hospitals nationwide had created rapid response teams (RRTs) in some form. The RRS is divided into its 2 basic components: the afferent limb and the efferent limb. Within this context, we will attempt to conceptualize the components of an RRS from the identification of patients at risk, the importance of nursing-led early deterioration recognition, use of early