Hospitalized patients sometimes experience a sudden worsening of their condition, requiring immediate, specialized attention outside of the Intensive Care Unit (ICU). Patient deterioration often shows warning signs for several hours before a catastrophic event occurs, such as cardiac arrest or respiratory failure. To address this gap in response time, hospitals established the Rapid Response System (RRS). The RRS is designed to bring critical care expertise directly to the patient’s bedside on general hospital floors. This system allows for quick assessment and stabilization, aiming to reverse the decline and prevent the need for more drastic emergency measures.
Defining the Rapid Response Team and Its Goal
The core component of the Rapid Response System is the Rapid Response Team (RRT), sometimes called a Medical Emergency Team (MET). This multidisciplinary group is specially trained to manage unstable patients and deliver advanced care quickly. The primary goal of the RRT is to prevent serious adverse events, including unexpected transfers to the ICU, in-hospital cardiac arrests, and patient death.
The RRT’s function differs distinctly from that of a “Code Blue” team, which is only activated after a patient has stopped breathing or their heart has stopped. A Code Blue is a reactive measure involving advanced life support and resuscitation efforts. The RRT, conversely, is a proactive intervention designed to stabilize the patient during the preceding period of physiological instability.
Catching patient decline early, often hours before a full arrest, allows for timely treatment that significantly improves survival. The RRT is deployed at the first sign of trouble, giving the team a window to intervene and reverse deterioration.
Criteria for Activation: When is the Team Called?
Activation of the RRT is based on specific, objective physiological changes known as “track-and-trigger” criteria. These criteria serve as an early warning system, alerting staff that a patient’s body is struggling to maintain normal function. Any staff member, and in some hospitals, even patients or family members, can initiate the call if they observe these signs or have a significant concern.
Common triggers relate to sudden changes in vital signs outside of a safe range. For example, a heart rate less than 40 or greater than 140 beats per minute triggers a call. Respiratory distress is also a major concern, indicated by a respiratory rate below 8 or above 28 breaths per minute.
Changes in blood pressure and oxygenation are frequently used criteria, such as a systolic blood pressure dropping below 90 mmHg or an oxygen saturation below 90% despite supplemental oxygen. An acute change in mental status, like new confusion or a sudden drop in the Glasgow Coma Scale score, is another indicator. Other triggers include uncontrolled pain, a threatened airway, or very low urine output over several hours.
Who Responds: Composition and Specialized Roles
The composition of the Rapid Response Team is multidisciplinary, ensuring specialized skill is immediately available at the bedside. While the exact makeup varies between institutions, the team is generally led by professionals with extensive critical care experience. This typically includes a Critical Care Nurse or an Intensive Care Unit (ICU) Nurse adept at advanced monitoring and rapid medication administration.
A Respiratory Therapist (RT) is an almost universal component of the RRT, specializing in airway management, breathing support, and oxygen delivery. The presence of an RT is valuable, as respiratory issues frequently cause patient deterioration. In many hospitals, a physician (such as a Hospitalist or an Intensivist) or an advanced practice provider (like a Nurse Practitioner or Physician Assistant) is also part of the core team.
The physician or provider has the authority to order immediate laboratory tests, imaging, and advanced treatments, as well as the expertise to make high-level decisions regarding the patient’s ongoing care. Some teams may also include a pharmacist to manage complex medication issues or a nursing supervisor for administrative support. This collection of specialized personnel ensures comprehensive and rapid stabilization.
The Rapid Response Intervention Process
The RRT intervention process begins the moment the team arrives at the patient’s bedside, often within a target time of 15 minutes. The initial action is a rapid, systematic assessment following the standard Airway, Breathing, and Circulation (A-B-C) protocol. The team introduces themselves and their roles, then gathers information using a structured communication tool, such as SBAR.
Immediate stabilization measures are implemented based on the assessment findings, which may include administering supplemental oxygen or initiating intravenous (IV) fluids. The critical care nurse often establishes large-bore IV access and prepares medications, while the respiratory therapist optimizes the patient’s respiratory status. The team works to quickly identify the root cause of the deterioration, ordering necessary labs, chest X-rays, or other diagnostic tests right at the bedside.
Following stabilization, the team determines the patient’s disposition, which is the decision about the next steps in their care. If the patient is successfully stabilized and the cause is manageable, they may remain on the general floor with higher monitoring and a modified care plan. Conversely, if the patient remains unstable or requires interventions only available in a higher acuity setting, the RRT facilitates an urgent transfer to the ICU.
The intervention concludes with thorough documentation of the event, including triggers, interventions, and outcomes. A formal handoff and debriefing with the primary care team ensures everyone understands the new plan and identifies any potential learning points for the staff. This structured process ensures continuity of care and reinforces proactive patient safety.