The unexpected deterioration of a patient’s condition often occurs hours before a serious event like cardiac arrest. Hospitals use specialized systems for early intervention, ensuring patients receive a higher level of care quickly, regardless of their location. These systems recognize that subtle changes in a patient’s status provide a window of opportunity to prevent a medical emergency. Understanding the precise circumstances that warrant an urgent call for help is fundamental to ensuring patient safety and improving outcomes.
What is a Rapid Response Team?
A Rapid Response Team (RRT), sometimes called a Medical Emergency Team (MET), is a multidisciplinary group of highly trained clinicians. They bring intensive care expertise directly to a patient’s bedside outside of the Intensive Care Unit (ICU). The team typically includes a critical care nurse, a respiratory therapist, and often a physician or physician assistant. The core mission of the RRT is to quickly assess, stabilize, and treat patients showing early signs of clinical decline, preventing further deterioration or cardiac arrest.
Key Physiological Triggers for Activation
The decision to call a Rapid Response Team is guided by specific, measurable changes in a patient’s vital signs, which signal impending distress. These triggers are organized into categories representing the body’s essential systems. Many institutions use a scoring tool, such as the Early Warning Score (EWS), where higher scores based on vital sign measurements prompt automatic RRT activation.
Respiratory Changes
The most common triggers involve signs of breathing difficulty, as respiratory compromise often precedes other complications. An abnormally fast breathing rate (tachypnea) is a frequent alarm, typically defined as greater than 28 breaths per minute in an adult. Conversely, a very slow rate, below 8 breaths per minute, is also a serious concern. A drop in oxygen saturation below 90%, especially if the patient is receiving supplemental oxygen, signals inadequate gas exchange and necessitates immediate attention.
Circulatory Changes
The cardiovascular system provides measurable triggers indicating a patient is struggling to maintain adequate blood flow. A sudden drop in systolic blood pressure to less than 90 millimeters of mercury (mmHg) suggests shock or severe fluid loss. Conversely, an extremely high systolic pressure, greater than 180 mmHg, can indicate a hypertensive emergency. Changes in heart rate are also significant, with rates greater than 140 beats per minute or less than 40 beats per minute being common activation criteria.
Neurological Changes
A sudden change in a patient’s mental status or level of consciousness is a serious indicator of deterioration. This can manifest as acute confusion, new unresponsiveness, or difficulty arousing the patient. These neurological shifts may signal inadequate oxygen supply to the brain, a dangerous metabolic imbalance, or a serious central nervous system event. Acute, uncontrolled pain or new, unrelieved chest pain can also be triggers, suggesting an underlying medical crisis that requires immediate attention.
Other Concerns
Other signs can warrant RRT activation, including a significant drop in urine output, such as less than 50 milliliters over a four-hour period. Many hospitals also include a criterion known as “staff concern” or “clinician intuition” as a valid reason to call the team. This acknowledges that an experienced clinician’s overall feeling that “something is wrong” with the patient, even without meeting a specific number threshold, is a powerful trigger for escalation.
The Caller’s Role and Activation Steps
The process of calling the RRT is designed to be straightforward and accessible, recognizing that time is precious during patient deterioration. Any staff member—including nurses, doctors, or therapists—is authorized to initiate the call immediately upon recognizing a trigger. The caller’s primary role is to quickly provide the patient’s name, exact location, and a concise description of the change in condition to the hospital operator.
Many hospitals have implemented Patient/Family Activated RRTs, sometimes called Condition H for “Help.” This empowers patients and their family members to bypass the standard chain of command if they perceive a concerning change that is not being adequately addressed. The most important step for a patient or family member is knowing the designated number or phrase to use for help, which is typically provided upon admission.
The Difference Between RRT and Code Blue
The distinction between calling a Rapid Response Team and calling a “Code Blue” is fundamental to understanding the RRT’s purpose. RRT activation is a proactive measure, called when a patient is alive but clearly deteriorating, with the goal of stabilization before a life-threatening event occurs. The patient still has a pulse and is breathing, but vital signs indicate high risk.
In contrast, a Code Blue is a reactive measure, called only when a patient has suffered a cardiopulmonary arrest. This means they have stopped breathing or their heart has stopped beating. The Code Blue team is the full resuscitation team, focused on advanced life support to revive the patient. Activating the RRT intervenes in the critical window of time, often six to eight hours, before the need for a Code Blue arises.