CURRENT DEBATE IN THE MEDICAL COMMUNITY centers on the benefits of rapid response teams (RRTs), hospital-based teams composed of clinicians with intensive care unit (ICU)–level clinical expertise. These teams rapidly respond when the condition of patients being cared for outside of the ICU suddenly deteriorates, and such patients often require transfer to ICUs. Those on one side of the debate suggest that RRTs save lives; this assertion is supported by common sense, numerous anecdotal reports, and some observational studies. Those on the other side of the debate suggest that preventing, recognizing, and treating deteriorating patients is common sense. How best to achieve this remains elusive based on systematic reviews, which have failed to show benefit of RRTs but note that RRT studies were often of poor quality and clinicians often failed to call an RRT when they should have, leading to uncertainty in the estimates of benefit. Proponents favor further research, encouraging hospitals to experiment with strategies such as RRTs, enhanced nurse staffing, or hospitalists who would respond to deteriorating patients, stressing prevention rather than recovery from deterioration. Those on both sides of the debate are united in their frustration that patients are needlessly experiencing morbidity and agree that preventing patients’ health from deteriorating is the optimal solution. The debate obscures a more fundamental question: why are RRTs needed in the first place? The answer seems to be simple. An RRT is needed when the condition of a patient who is receiving care in a medical/surgical unit deteriorates or requires ICU-level expertise to avoid further deterioration or even death. There are 2 reasons patients deteriorate. First, some deteriorate despite adequate clinical care. These patients would benefit from having an organized system to identify and treat patients whose conditions worsen, such as an RRT or code team. Second, patients deteriorate because of inadequate care; in other words, the level of care (eg, clinician training, staffing) provided to the patient in the inpatient unit is inadequate for the patient’s condition. Even though empirical evidence regarding the proportion of RRT calls caused by each of these reasons is lacking, the philosophy of RRTs is premised on the idea that current care is inadequate; therefore, introducing ICU-level care will benefit the patient. If current care is adequate, an RRT is not likely to make a difference. Underlying inadequate care is that patients have been admitted to a unit that provides inadequate care. A triage error or inability to admit or transfer a patient to the preferred unit is the main driver of patient misplacement. Underlying the triage error is the way patient flow is managed or mismanaged. Every physician and nurse would prefer that patients are cared for in a unit that can provide the appropriate level of care, where sufficient physician, nurse, and monitoring resources are available. Physicians commonly request that their patients remain in the ICU or are admitted to a specific nursing unit, often with monitored beds, believing care is better in some units than others. Intensive care units and monitored beds are scarce resources, demand for these resources periodically exceeds supply, and patients are often not admitted to these preferred units. This situation is especially problematic in hospitals without critical care physicians who use clearly defined protocols to coordinate the use of monitored beds. A common although often erroneous solution is to add more ICU and monitored beds. Even if the cost of adding a bed (about $1 million capital for a regular inpatient bed) is ignored, experience suggests that adding more beds does not solve this problem. Eventually, demand for these beds will again exceed capacity. Why, then, is there a seemingly insufficient number of ICU and monitored beds? Why don’t hospitals define which patients should use ICU and monitored beds? One reason is that mismanaged patient flow in the form of artificial peaks does not allow compliance with any such definition. Despite average US hospital occupancy of 66% to 67%, hospitals are periodically overcrowded. The key word is “periodically.” Rarely are particular hospital units overcrowded 100% of the time, in which case more beds would be needed. Rather, these hospitals are typically overcrowded on cer-