Rapid Response Systems History and Terminology

Abstract

The Rapid Response System (RRS) concept has matured substantially since its inception in the early 1990s when critical care physicians, primarily in Australia; Pittsburgh, PA; and the UK started asking some crucial questions regarding why and how patients on general hospital ward deteriorate and often arrest without effective intervention prior to a terminal or near-terminal event. Specifically, they asked exactly what is happening to general hospital ward patients in the minutes and hours prior to their cardiorespiratory arrests and whether we can do something to intervene and halt these deteriorations prior to arrest. This was a sea change in thought and perspective since, at that time, resources focused on resuscitation were primarily concerned with how to improve performance of CPR and ACLS rather than preventing the event to start with. Critical care physicians were well aware, in a general sense, that patients admitted or readmitted to the ICU from the general ward uncommonly went from “just fine” to critically ill. This sense was confirmed by early studies that clearly showed that arrests and deteriorations were not sudden but rather commonly heralded by long periods of obvious hemodynamic and respiratory instability that was often unappreciated by general ward providers. Deteriorating general ward patients were not “suddenly critically ill”; they were only “suddenly recognized” as critically ill, and there is clearly time to intervene.