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Title: Rapid Response Systems 20 Years Later: New Approaches, Old Challenges
Authors: Bonafide, Christopher P.
Roland, Damian
Brady, Patrick W.
First Published: 1-Aug-2016
Publisher: American Medical Association (AMA)
Citation: JAMA Pediatrics, 2016, 170 (8), pp. 729-730
Abstract: In 1990, Schein and colleagues changed the paradigm of in-hospital cardiopulmonary arrest. Their report, “Clinical Antecedents to In-Hospital Cardiopulmonary Arrest,” provided evidence from adults suggesting that many arrests could have been prevented if existing signs of deterioration were identified, interpreted, communicated, and responded to appropriately.1 Five years later, Liverpool Hospital published the first report of a rapid response system.2 This marked the start of a patient safety movement that spread quickly to children’s hospitals.3 Rapid response systems aim to improve the detection and management of deterioration in hospitalized patients. They combine tools to help clinicians identify deterioration with medical emergency teams that can be summoned to the bedsides of ill patients. Rapid response system implementation was associated with reductions in cardiopulmonary arrests (relative risk [RR], 0.62 [95% CI, 0.46-0.84]) and mortality (RR, 0.79 [95%CI,0.63-0.98]) in a recentmeta-analysis,4 and reversed a trend of increasing critical deterioration events (a more proximate outcome) in a quasi-experimental study.5Duein part tomountingevidence,commonsense appeal, and their inclusion in major initiatives like the Institute for Healthcare Improvement’s 5 Million Lives Campaign, rapid response systems are now nearly universally present in hospitals worldwide. Unfortunately, rapid responsesystemshavenotfully solved the problem they targeted 20years ago, and, despite progress, the challenges in pediatrics remain complex. Children still deteriorate on hospital wards, and 40% or more of these events may be preventable.6 There is an opportunity to renew the enthusiasm that surrounded the first generation of rapid response systemwork, which focused primarilyonthe medicalemergency team response, to pursue the more difficultwork of optimizing the identification of deteriorating children. Below we propose a set of recommendations for a research agenda aimed at addressing this challenge. [Introduction]
DOI Link: 10.1001/jamapediatrics.2016.0398
eISSN: 2168-6211
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © American Medical Association (AMA), 2016. This version of this article is distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License ( ), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Description: Following the embargo period the above license applies.
Appears in Collections:Published Articles, Dept. of Health Sciences

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