title: Barriers to activation of the rapid response system.
abstract: BACKGROUND
  The rapid response system (RRS) has been widely implemented in the US. Despite efforts to encourage activation of the RRS, adherence to activation criteria remains suboptimal. Barriers to adherence to RRS activation criteria remains poorly understood.
  
  
  OBJECTIVE
  To identify barriers associated to activation of the RRS system by clinical staff.
  
  
  METHODS
  Physicians and nurses on the medical and surgical wards of a New York City community hospital were surveyed to identify barriers to six criteria for activation of the RRS. A paper questionnaire was disseminated. We assessed familiarity with, agreement with, and recognition of perceived benefit of the RRS calling criteria using a Likert scale. Self-reported adherence to RRS activation was also measured on a Likert scale. Logistic regression was used to assess the association between the barriers and the six RRS criteria.
  
  
  RESULTS
  Sixty eight physicians and 16 nurses completed the survey; response rates were 59% and 35%, respectively. Self-reported adherence rate was ≤25% for the six criteria. We observed that as the familiarity with, agreement with, and perceived benefit of activating the RRS increases, the self-reported adherence also increases.
  
  
  CONCLUSIONS
  Adherence to activation of RRT based on the six criteria measured is low. As familiarity with, agreement with, and perceived benefit of the RRS activating criteria rise, self-reported adherence rates increase, with familiarity having the greatest impact. These results can be used to develop tailored interventions to increase adherence to RRT activation in health care institutions.
authors.affiliation: Division of Medicine, Harlem Hospital Center New York, New York, NY 10037, USA. Electronic address: od2178@columbia.edu.
authors.forename: Oluwaseun
authors.initials: O
authors.lastname: Davies
authors.affiliation: Director Critical Care, Harlem Hospital Center New York, New York, NY 10037, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: DeVita
authors.affiliation: Chief, Pulmonary & Critical Care, Harlem Hospital Center New York, New York, NY 10037, USA.
authors.forename: Raji
authors.initials: R
authors.lastname: Ayinla
authors.affiliation: Division of Medicine, Harlem Hospital Center New York, New York, NY 10037, USA.
authors.forename: Xavier
authors.initials: X
authors.lastname: Perez
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D016001:Confidence Intervals; D003422:Critical Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D009519:New York City; D010348:Patient Care Team / Q000458:organization & administration; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
keywords: Activation barriers; Afferent limb failure; Medical emergency team; Physician and nurse attitudes, Knowledge and behavior; Rapid response system