The document describes a Rapid Response Team (RRT) and its purpose and functions. An RRT is a multidisciplinary team that provides critical care expertise to patients outside of ICU who show signs of deterioration. The key purposes of an RRT are to assess and stabilize deteriorating patients, provide support and early interventions to prevent further decline, and communicate with physicians. An effective RRT process includes detection of issues, team activation, response and assessment at the bedside, interventions and stabilization, and disposition/evaluation. The document outlines roles and responsibilities of the RRT, calling criteria, and how to structure, implement, and measure the effectiveness of an RRT.

1. Rapid Response
Team - RRT
Ahmad Thanin

2. Definition
• is a formally designated multidisciplinary
team that assesses and manages a patient
who has demonstrated early signs of
deterioration in clinical status, prior to the
development of progressive and irreversible
deterioration.
rapid response team
• is a group of clinicians that nurses and other
hospital staff can call upon at any time to
provide critical care expertise at the bedside
of a patient whose condition is deteriorating
rapid response team

3. WHAT IS Its PURPOSE?
To provide support and counseling to healthcare
workers outside the critical care units
To provide critical care expertise, support and
early interventions to patients who show signs of
deterioration outside the critical care units and
communicate with responsible physician in order
to improve patient’s outcome

4. RAPID
RESPONSE
PROCESS
Detection
Activation
Response, Assessment,
Intervention and Stabilization
Disposition
Evaluation

5. What Is the Role of the Rapid Response Team?
Assess Stabilize
Assist with
communication
Educate and
support
Assist with
transfer, if
necessary
Follow-up of
discharged
patients

6. Rapid
Response
• Respond.
• Assess.
• Provide support.
• Intervene.
• Delegate.
Rapid
• Reassess.
• Educate.
• Support.
• Plan.
• Organize.
• Negotiate.
• Stabilize and transport.
• Evaluate.
Response

7. Typical Rapid Response System Calling Criteria
• Heart rate over 140/min or less than 40/min
• Respiratory rate over 28/min or less than 8/min
• Systolic blood pressure greater than 180 mmHg or less than 90 mmHg
• Oxygen saturation less than 90% despite supplementation
• Acute change in mental status
• Urine output less than 50 cc over 4 hours
• Staff member has significant concern about the patient's condition
Any staff member may call the team if one of the following criteria is met:
• Chest pain unrelieved by nitroglycerin
• Threatened airway
• Seizure
• Uncontrolled pain
Additional criteria used at some institutions:

8. Modified Early
Warning Score
(MEWS)
The Modified Early Warning Score
(MEWS) is a simple, physiological score
that may allow improvement in the
quality and safety of management
provided to surgical ward patients.
The primary purpose is to prevent delay
in intervention or transfer of critically ill
patients

9. Why is MEWS being Implemented?
Most adverse events are usually preceded by early warning signs of
preceded by early warning signs of clinical instability.
Early signs are more often subtle changes in multiple parameters
rather than a dramatic change in an isolated value.
More informative “vital signs” could prevent failure to recognize
early deterioration.

10. Modified Early Warning Score (MEWS) for Clinical Deterioration before calling RRT
• PRESS HERE

11. Guidelines for nursing department
SCORE
0 - 2 • continue the routine monitoring of the vital signs.
3 • Continue every 4-hour vital sign monitoring and calculate MEWS Score
• If patient remain at score 3 for three consecutive reading, call the charge nurse to assess patient
4 • Inform charge nurse and patient’s physician
• The charge nurse assesses the patient and notifies the nurse manager director of patient status
• Increase vital sign monitoring frequency to 2 hours intervals and calculate the MEWS Score.
• Measure intake and output and notify in charge nurse if urine out put fall below 100 ml every 4 hours.
5 • Inform patient's physician and request assessment of the patient by the physician
• Increase frequency of vital sign monitoring including pulse oximetry hourly.
• If patient remain 5 score 3 for three consecutive reading, request transfer to higher level of care
+6 • Call RRT and the treating physician..
• transfer to higher level of care

12. Remember
( code blue is the proper
call)
Do not activate or call for
Code RRT if the patient
need resuscitation

13. RRT Vs. Code Blue
ITEM RRT Code Blue
Airway Present always Absent
Breathing Present Always Absent
Circulation Present Always Absent
First Action Assessment CPR or D.C Shock
Level Of consciousness Conscious or semi conscious Unconscious
Medication Depend on patient situation Follow ACLS Algorithms
GCS GCS decreases by 2 points over 2 hrs. Quick Drop of GCS .

14. How to Implement a Rapid Response Team
Prior to testing and implementation of a Rapid Response Team,
organizations may wish to consider the following:
• Engage senior leadership support.
• Determine the best structure for the Rapid Response Team.
• Establish criteria for activation of the Rapid Response Team.
• Establish a simple process for activating the Rapid Response Team.
• Provide education and training.
• Use standardized tools.
• Establish feedback mechanisms.
• Measure effectiveness

15. Engage Senior Leadership Support
Make an explicit organizational commitment to establishing the
Rapid Response Team.
Make
Educate the medical staff about the benefits of Rapid Response
Team and put the myths to rest.
Educate
Craft a very clear and widely disseminated communication
message from senior leadership.
Craft

16. Determine the
Best Structure
for the Rapid
Response Team
ICU RN, RT, Intensivist or Hospitalist
ICU RN and Respiratory Therapist (RT)
ICU RN, RT, Intensivist, Resident
ICU RN, RT, Physician Assistant
ED or ICU RN

17. four key features
of Rapid
Response Team
members
The team members must be available to respond
immediately when called.
They must be onsite and accessible.
They must have the critical care skills necessary to
assess and respond.
They must respond to every call with a smile on their
face and a script that may include, “Thank you for
calling. How can I help you?

18. THE MEMBERS OF A RAPID
RESPONSE TEAM MAY INCLUDE:
• Critical Care Nurse
• Respiratory Therapist
• Primary RN
• Critical Care Physician
• Nursing Supervisor

19. Mandatory certification for RRT Team members
Basic Life Support
Advanced Cardiac Life Support

20. Establish Criteria
for Activating the
Rapid Response
Team, Example
criteria include
Staff member is worried about the patient
Acute change in heart rate <40 or >130 bpm
Acute change in systolic blood pressure <90
mmHg
Acute change in respiratory rate <8 or >28 per
min
Acute change in saturation <90% despite O2
Acute change in conscious state

21. When does the team leave? At disposition?
It really depends on the patient and the model you choose
to use at your facility.
May leave after the initial intervention.
If your Rapid Response Team consists of RNs and RTs,
one or more of the team members may stay with the
patient until they go to ICU.