title: Rapid response systems: a prospective study of response times.
abstract: OBJECTIVE
  The purpose of the study was to evaluate the time taken for delivery of each component of care following patient deterioration and to assess the effect on response times of strategies implemented to improve the system.
  
  
  METHODS
  A model identifying the sequence of organizational responses following a patient's unexpected clinical deterioration was developed. The time to key events and interventions from initial deterioration was measured for 3 months in 2005 and again in 2006 at a tertiary care hospital with a rapid response team (RRT) in place. Strategies to improve compliance with the RRT system were introduced between the 2 periods.
  
  
  RESULTS
  The number of acute deterioration episodes identified increased (61 episodes in 2005; 154 episodes in 2006), but there was no improvement in response times. The 2 components contributing most frequently to delays were the time for nursing staff to call for assistance and, where needed, for physicians to call for higher-level care. Overall, 26% of episodes in 2006 and 30% in 2005 did not receive medical attention within 30 minutes of acute deterioration.
  
  
  CONCLUSIONS
  Significant delays in responding to acute deterioration persist despite strategies to facilitate the functioning of the RRT system. Simple strategies such as policy directives are not sufficient to effect change in complex health care systems.
authors.affiliation: Centre for Health Services and Workforce Research, Westmead Hospital, Sydney West Area Health Service, Australia.
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Adelstein
authors.forename: Michael A
authors.initials: MA
authors.lastname: Piza
authors.forename: Vineet
authors.initials: V
authors.lastname: Nayyar
authors.forename: Yugan
authors.initials: Y
authors.lastname: Mudaliar
authors.forename: Peter L
authors.initials: PL
authors.lastname: Klineberg
authors.forename: George
authors.initials: G
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult