Objectives: Rapid response systems address unexpected and unrecognized clinical deterioration on general hospital wards and aim to prevent cardiorespiratory arrests. These systems have an afferent limb (recognition and activation) and an efferent limb (response). Our main objectives were to determine the effectiveness of rapid response systems on patient safety and clinical outcomes and how rapid response systems can be implemented effectively.
Methods: We searched PubMed and the Cochrane library for eligible systematic reviews and primary studies published from January 2018 through June 2023, supplemented by targeted gray literature searches. We included reviews and primary studies of rapid response systems reporting the incidence of cardiorespiratory arrest, hospital mortality, transition to higher level of care, serious adverse events related to clinical deterioration, or unintended consequences.
Findings: We retrieved 867 citations, of which 23 articles were eligible for review (4 systematic reviews and 19 primary studies). Three categories of interventions were identified: implementation of a new system, modifications to the afferent limb, and modifications to the efferent limb. Based on systematic reviews and primary studies, rapid response systems may have a large impact in reducing in-hospital mortality (low strength of evidence for adult and pediatric populations) and an even greater impact in reducing the incidence of cardiorespiratory arrest on hospital general wards in adult populations (low strength of evidence), but the effect is unclear in pediatric populations (insufficient strength of evidence). Their impact on unanticipated intensive care unit (ICU) admission is unclear (insufficient strength of evidence for both populations). Modifications to the afferent and/or efferent limb were associated with a reduction in mortality and the incidence of cardiorespiratory arrest for adults (low strength of evidence) but the evidence was insufficient in pediatric populations. Serious adverse events (e.g., arrest soon after ICU arrival) were infrequently reported (insufficient strength of evidence for both adult and pediatric populations). One included systematic review of the unintended consequences of staffing models examined risks for ICU patients, but the strength of evidence was insufficient for both children and adults.
Conclusions: Overall, rapid response systems may have a large beneficial effect on the outcomes of hospital mortality and the incidence of in-hospital cardiorespiratory arrest but the strength of the evidence is low due to methodological weaknesses of the studies. Innovations in afferent and efferent limb structures show promise for increased benefit.