Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient?
Article first published online: 28 OCT 2010
© 2010 Blackwell Publishing Ltd
Journal of Clinical Nursing
Volume 19, Issue 23-24, pages 3260–3273, December 2010
How to Cite
Massey, D., Aitken, L. M. and Chaboyer, W. (2010), Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient?. Journal of Clinical Nursing, 19: 3260–3273. doi: 10.1111/j.1365-2702.2010.03394.x
- Issue published online: 17 NOV 2010
- Article first published online: 28 OCT 2010
- Accepted for publication: 1 June 2010
- Critical Care Outreach Teams;
- integrative review;
- Medical Emergency Teams;
- rapid response systems;
- the deteriorating patient
Aims. To conduct a literature review that explores the impact of rapid response systems on reducing major adverse events experienced by deteriorating ward patients.
Background. Patients located on hospitals wards are frequently older, have multiple co-morbidities and are often at risk of life-threatening clinical deterioration. Rapid response systems have been developed and implemented to provide appropriate and timely intervention to these patients.
Design. A comprehensive review of the literature.
Methods. This review used the rapid response systems framework recently developed by experts in the area. Medline, CINAHL, Embase and Cochrane databases were searched from January 1995–June 2009. Sixteen papers were selected that most clearly reflected the research aim. Each paper was critically appraised and systematically assessed. Major themes and findings were identified for each of the studies.
Results. The effectiveness of rapid response systems in reducing major adverse events in deteriorating ward patients remains inconclusive. Six studies demonstrated that the introduction of a rapid response systems positively impacted on patient outcomes, but three studies demonstrated no positive impact on patient outcomes. Nursing staff appear reluctant to use rapid response systems; the rationale for this is unclear. However, the continued underuse and inactivation may be one reason why research findings evaluating rapid response systems have been inconclusive.
Conclusions. The paper illustrates two important gaps in the literature. First, ‘ramp-up’ systems have not been subjected to formal evaluation. Second, rapid response systems are under-activated and underused by nursing staff. There is an urgent need to explore the reasons for this and to identify interventions to improve the activation of these systems in an effort to promote safe and effective care to the deteriorating ward patient.
Relevance to clinical practice. Rapid response systems are multidimensional models. They are relatively new innovations that have important implications for clinical research and implementation policy. This review contributes to the emerging debate on rapid response systems.