Why is it so difficult to prove that rapid response systems improve patient outcome? : Directions for further research

Abstract

The implementation of rapid response systems (RRS) is based on the knowledge that deteriorating physiological processes are frequently present for hours or days before clear clinical deterioration is recognized [1,2]. It is assumed that this physiological deterioration is often treatable and that treatment will have greater effect when initiated early [3]. The RRS consists of an afferent limb, including “crisis detection” and “response triggering” and an efferent limb, the rapid response team (RRT) [4]. Even though robust evidence to support the effectiveness of the RRS is lacking [5-10] the system has been implemented worldwide. For example, Dutch hospitals are required to implement a patient safety programme including an RRS before 2013 [11]. This article explores the reasons why it is so difficult to prove the effectiveness of an RRS. We discuss the study designs that have been used and the various outcome measures in order to estimate the effects of an RRS. Finally, we make suggestions for future research.