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September 22/29, 2010

Rethinking Rapid Response Teams

Author Affiliations

Author Affiliations: Institute for Healthcare Optimization, Newton, Massachusetts (Dr Litvak); Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts (Dr Litvak); and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, and Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Pronovost).

JAMA. 2010;304(12):1375-1376. doi:10.1001/jama.2010.1385

Current debate in the medical community centers on the benefits of rapid response teams (RRTs), hospital-based teams composed of clinicians with intensive care unit (ICU)–level clinical expertise. These teams rapidly respond when the condition of patients being cared for outside of the ICU suddenly deteriorates, and such patients often require transfer to ICUs.1 Those on one side of the debate suggest that RRTs save lives; this assertion is supported by common sense, numerous anecdotal reports, and some observational studies.2 Those on the other side of the debate suggest that preventing, recognizing, and treating deteriorating patients is common sense. How best to achieve this remains elusive based on systematic reviews,3 which have failed to show benefit of RRTs but note that RRT studies were often of poor quality and clinicians often failed to call an RRT when they should have, leading to uncertainty in the estimates of benefit. Proponents favor further research, encouraging hospitals to experiment with strategies such as RRTs, enhanced nurse staffing, or hospitalists who would respond to deteriorating patients, stressing prevention rather than recovery from deterioration. Those on both sides of the debate are united in their frustration that patients are needlessly experiencing morbidity and agree that preventing patients' health from deteriorating is the optimal solution.

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