What is it about?
The Rapid Response System (RRS) allows the presence of critical care experts at the patient's bedside in general wards. It has been introduced to provide an early response to clinical deterioration and to prevent cardiac arrest, unexpected death, or the need to transfer patients to an intensive care unit (ICU). Controversies still arise concerning the effectiveness of this complex intervention. Several non-randomized trials with historical control groups (pre-and post-implementation) exist but randomized controlled trials are lacking. However, aggregate data of the meta-analyses show a statistically significant reduction of in-hospital cardiac arrest and hospital mortality in adult patients associated with the deployment of RRSs.
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Why is it important?
The RRS works as a wide-hospital system, which relies on an integrated set of four components that must interact with each other and with patients. The complexity of the system does not allow to consider experimental trials only as the most appropriate method to meet research objectives. Several studies well-designed, including observational, quasi-experimental with a non-randomized control group, and experimental, provide high-quality and strong evidence of improvement in the clinical outcomes after the implementation of RRSs. Despite the controversies, this model for in-hospital emergencies has been worldwide introduced to provide an early response to clinically deteriorating patients. Furthermore, the benefits of the RRS depend on its proper use and on barriers and facilitators that may affect its integration within the hospital.
Perspectives
This article focuses on an important question and the criticisms it raises. The issue concerns the peculiarity of the RRS, a complex intervention working in a complex system such as the hospital. Randomized controlled trials are the appropriate instrument for evaluating a new pharmacologic therapy or to establish the best efficacy of one treatment over another. However, experimental studies with a randomized controlled design may not be suitable for evaluating a complex intervention such as the RRS, which has been proposed to improve the management of hospitalized patients outside an ICU.
Professor (Adjunct) Marcello Difonzo
Degree in Nursing, School of Medicine, University of Bari Aldo Moro, Bari, Italy. Di Venere teaching hospital, Bari, Italy
Read the Original
This page is a summary of: Rapid Response Systems: how to interpret levels of evidence, Clinical Management Issues, July 2017, Seed SRL,
DOI: 10.7175/cmi.v11i2.1271.
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