Even under the best of circumstances, outcomes for patients who experience in-hospital cardiac arrest (IHCA) are bleak. IHCA affects an estimated 292,000 adults in the United States per year, and only 1 in 4 survive.1,2 With statistics like those, it makes sense to consider not only how to optimize Code Blue response, but also how to prevent cardiac arrest from happening in the first place.
That’s where rapid response teams come in. Made up of critical care clinicians, these teams are trained to respond promptly to the bedside of any patient showing warning signs of deterioration. And while the structure, design, and implementation of the teams vary across hospitals, the concept is the same: identify at-risk patients and intervene early to prevent an emergency event.
Rapid response teams have become a popular solution in hospitals since they began to take hold in the mid-2000s. So it’s worth asking the question: Do they work? More specifically, how do they benefit patients and staff, where do they fall short, and what does it all mean for hospitals? Keep reading to find out.
The rise of rapid response teams
Rapid response teams first emerged in Australia in the 1990s, but it was a decade later before they began to increase in popularity. In 2005, the Institute for Healthcare Improvement (IHI) launched its 100,000 Lives Campaign, a six-pronged approach to improving hospital outcomes.3 Rapid response teams were a key component of the program, and their popularity began to take off from there.
Changing hospital culture
While the IHI initiative was the trigger, the rise of rapid response teams was also made possible by a more gradual mindset shift occurring among healthcare workers. Historically, hospital culture was marked by widespread reluctance to ask for support during early patient deterioration. Nurses didn’t have a process to reach out, and they feared that doing so would make them appear weak or incapable. And when they did muster up the confidence to escalate the situation, residents and physicians would often underestimate or disregard their assessment. Thanks to these less-than-ideal dynamics, it was not uncommon for a deteriorating patient to stay in the medical-surgical unit rather than transfer to the intensive care unit (ICU) — where they likely would have received more appropriate care and monitoring.
Fortunately, the go-it-alone mindset gradually began to change for the better as clinicians realized that a team-based approach often served patients’ needs best.
The shift toward a more team-oriented approach paved the way for increasing adoption of rapid response teams following the IHI’s campaign. And today, rapid response teams are a key strategy of IHCA prevention in most acute care hospitals across the United States.4
How do rapid response teams benefit patients?
In theory, the benefits of a rapid response team should be fairly obvious. Studies show that patients typically demonstrate signs of deterioration up to 12 hours before they go into arrest.5 And since a rapid response team is designed to recognize those signs and intervene early, it’s logical to expect better outcomes and more lives saved. Nurses also believe in the benefits of rapid response, reporting that it allows them to better care for deteriorating and acutely ill patients.6
But does the research support these assumed and perceived benefits? In reality, the data on rapid response teams and patient outcomes is more mixed than you might think. Let’s take a look:
- On the positive end of the spectrum, data indicates that rapid response teams help prevent and reduce rates of cardiac arrest outside the ICU.7
- On the other hand, studies do not show that rapid response decreases overall mortality rate in hospitals.7,8
The bottom line: Data doesn’t demonstrate a clear, overwhelming benefit when it comes to rapid response and patient outcomes. While these teams can help prevent cardiac arrest outside of the ICU, the evidence doesn’t indicate a positive impact on the overall mortality rate.
How do rapid response teams benefit staff?
When it comes to nurse satisfaction, the advantages of rapid response are much clearer. Nurses play a crucial role in rapid response and are often the first to activate the team when a patient shows signs of deterioration. They benefit from rapid response in several key areas:
Education and skill building
Once rapid response is called, the idea isn’t for nurses to step aside and allow members of the team to take over. Instead, the goal is for the critical care clinicians to work side-by-side with the nurse who activated the response. Nurses benefit from this real-time education and are able to build their knowledge base and develop clinical skills related to patient deterioration.9
Of all clinical staff, nurses often spend the most time with the patient. As a result, they are uniquely positioned to notice and sound the alarm when something seems off, even in cases when it’s based largely on gut instinct. Rapid response systems recognize and capitalize on this strength — and in doing so, empower nurses to activate early intervention for patients in need.
For nurses, the multidisciplinary, team-based approach of rapid response reduces stress and alleviates the pressure to care for a patient without help or support. And with many hospitals and ICUs currently filled to capacity, nursing stress levels are higher now than ever. Supporting nurses in managing deteriorating and acutely ill patients is especially important in this context.
Now that we’ve taken a closer look at the data, what does it mean for hospitals? Here’s our take:
1. Although the data is mixed, rapid response still offers clinical benefits. No, the data doesn’t show an overwhelming benefit when it comes to patient mortality. But there are still important advantages to consider, like a reduced number of cardiac arrests outside the ICU. Many patients will benefit from careful surveillance of their health status and prompt intervention based on objective biological data.
2. The benefits to nursing staff are significant and should not be overlooked. For nurses, rapid response teams reduce stress, empower them to reach out, and strengthen their clinical skills. Particularly at a time when hospitals are facing staffing shortages and nurse retention challenges, it’s crucial not to disregard these other (seemingly less tangible, but equally valuable) benefits of rapid response.
3. Optimization and continuous quality improvement can help hospitals get the most out of rapid response. Although rapid response teams are common, their structure and implementation vary considerably across hospitals. It’s worth experimenting with different approaches and considering how your team might be changed or improved — for the benefit of patients and staff alike. For example, one study of rapid response teams found that high-performing IHCA hospitals were more likely to have4:
- Dedicated rapid response staff (versus staff with competing clinical responsibilities)
- A culture that empowered nurses to activate the response based on their own judgment, rather than checking in first with a physician
- Strong collaboration and engagement with bedside nurses both during and after the response
For hospitals looking to optimize their existing team, these kinds of considerations can serve as a good starting point. Regularly evaluating the rapid response system, gathering feedback, and making improvements can help improve both staff satisfaction and patient outcomes.
Next, learn how rapid response teams and electronic monitoring can help prevent severe sepsis and sepsis-associated cardiac arrest.
Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020 Mar;141:e139-e156. https://doi.org/10.1161/CIR.0000000000000757
Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019 July;12:1-8.
Rapid response teams: The case for early intervention. (2022). https://www.ihi.org/. Retrieved November 2, 2022, from https://www.ihi.org/resources/Pages/ImprovementStories/RapidResponseTeamsTheCaseforEarlyIntervention.aspx
Dukes, K., Bunch, J. L., Chan, et. al. (2019). Assessment of rapid response teams at top-performing hospitals for in-hospital cardiac arrest. JAMA Internal Medicine, 179(10), 1398. https://doi.org/10.1001/jamainternmed.2019.2420
Churpek, M. M., Yuen, T. C., Winslow, C., Robicsek, A. A., Meltzer, D. O., Gibbons, R. D., & Edelson, D. P. (2014). Multicenter development and validation of a risk stratification tool for ward patients. American Journal of Respiratory and Critical Care Medicine, 190(6), 649–655. https://doi.org/10.1164/rccm.201406-1022oc
Stolldorf, D. P. (2016). Original research. The benefits of rapid response teams: Exploring perceptions of nurse leaders, team members, and end users. AJN, American Journal of Nursing, 116(3), 38–47. https://doi.org/10.1097/01.naj.0000481279.45428.5a
Winters, B. D., Weaver, S. J., Pfoh, E. R., Yang, T., Pham, J., & Dy, S. M. (2013). Rapid-response systems as a patient safety strategy. Annals of Internal Medicine, 158(5_Part_2), 417. https://doi.org/10.7326/0003-4819-158-5-201303051-00009
Chan, P. S. (2010). Rapid response teams. Archives of Internal Medicine, 170(1), 18. https://doi.org/10.1001/archinternmed.2009.424
Jones, D., Baldwin, I., McIntyre, T., et. al. (2006). Nurses’ attitudes to a medical emergency team service in a teaching hospital. Quality and Safety in Health Care, 15(6), 427–432. https://doi.org/10.1136/qshc.2005.016956