title: Rapid response: a quality improvement conundrum.
abstract: Many in-hospital cardiac arrests and other adverse events are heralded by warning signs that are evident in the preceding 6 to 8 hours. By promptly intervening before further deterioration occurs, rapid response teams (RRTs) are designed to decrease unexpected intensive care unit (ICU) transfers, cardiac arrests, and inpatient mortality. While implementing RRTs is 1 of the 6 initiatives recommended by the Institute for Healthcare Improvement, data supporting their effectiveness is equivocal. Before implementing an RRT in our institution, we reviewed cases of failure to rescue and found that (1) poor outcomes were often associated with attempts to manage early decompensations without a bedside evaluation, and (2) the common causes of decompensation for floor patients (early sepsis, aspiration, pulmonary embolism) were within the scope of our primary teams' practice. Therefore, we felt that prompt, mandatory bedside evaluations by the primary team would decrease untoward outcomes.
authors.affiliation: Department of Medicine, University of Colorado Denver Health Sciences Center, Denver, CO, USA.
authors.forename: Renata
authors.initials: R
authors.lastname: Prado
authors.forename: Richard K
authors.initials: RK
authors.lastname: Albert
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Chu
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D003919:Diabetes Insipidus / Q000139:chemically induced / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced / Q000150:complications; D018020:Lithium Compounds / Q000009:adverse effects; D008609:Mental Status Schedule / Q000592:standards*; D008875:Middle Aged; D010351:Patient Discharge; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy; D013923:Thromboembolism / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D018020:Lithium Compounds; D006493:Heparin; D010959:Tissue Plasminogen Activator