Who You Gonna Call? Evolution of a Rapid Response Team

Introduction: In 2005, our hospital implemented a rapid response team (RRT) to prevent deaths and clinical deterioration in patients outside of the intensive care unit. Over the course of 19 years, this team evolved into the Medical Emergency Response Committee (MERC) which has oversight of all emergency response teams including rapid response and medical emergencies. The objective of this initiative was to assess whether a centralized emergency response system could improve patient outcomes and consistent care processes across the hospital utilizing robust data collection and systematic process improvement.


Methods: In its inaugural year, the RRT was a small charter organization with a physician lead and no formal reporting structure with 33 RRT calls for a 280-bed hospital. As the system grew a new structure to support emergency response was needed. With executive sponsorship, the MERC was developed as a high reliability interdisciplinary team committed to process improvement. MERC created a groundwork of weekly review of all RRTs and medical emergencies. These supported the expansion and creation of additional teams such as stroke, airway and behavioral that have shown improvement in patient outcomes.


Results: In 2015, the hospital increased to 516 beds, 1219 rapids with 162 cardiac arrests growing to 776 beds, 4292 rapids and 269 cardiac arrests in 2024. This equates to a 50% growth in hospital size with a 252% increase in of RRT activations and only a 66% increase in in-hospital cardiac arrests with 32% of those occurring outside of the ICU. This growth in activations with a lower proportional rise in arrests suggests earlier intervention improves patient outcomes. Structured weekly debriefs have resolved more than 4,000 clinical and non-clinical concerns over the past 9 years.


Conclusions: The original RRT has grown to become a high-level system of multiple emergency response teams with significant success stories. Within this structure, MERC addresses process improvement issues and improves quality of care interacting with every department across the organization to recognize clinical deterioration trends and adapt its framework to embrace a changing organization. This multidisciplinary identification system champions practice growth and supports an academic culture embracing quality improvement.