Failure to Rescue: a Focus on Improvement of RRT Activation to Reduce In-Hospital Cardiac Arrests

Introduction: A Rapid Response Team (RRT) is a designated group of hospital staff trained to care for deteriorating patients. Even in high-resource settings, sociocultural, organizational, and technical barriers can limit the use of RRTs. The 2023 SCCM Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU strongly recommend implementing hospital-wide explicit RRT activation criteria. This led to changes in how RRT activations occur at our large urban academic medical center.


Methods: From June 2023 to June 2025, a large urban academic medical center reviewed all RRT activations and Code Blues. A multidisciplinary subcommittee also reviewed RRT activations quarterly. Initially, this subcommittee focused on assessing current practices related to RRT activation. In the absence of explicit criteria, they developed and distributed new clinical criteria to providers and included them in weekly training with nursing leadership. The number of RRT calls and OOICU cardiac arrests from January 2024 to June 2025 was recorded monthly; this data was analyzed using Spearman correlation and Poisson regression models to determine correlation and association, respectively.


Results: An RRT was called 3,827 times; during that period, 162 OOICU cardiac arrests were recorded. There was a 24.7% increase in RRT usage and a 36.4% decrease in OOICU arrests. Spearman correlation analysis showed a statistically significant negative correlation (ρ = –0.55, p = 0.02) between RRT calls and OOICU cardiac arrests. Poisson regression modeling indicated that increased RRT activity was significantly associated with fewer OOICU cardiac arrests (coefficient = –0.007, p = 0.014), with each additional RRT call linked to a 0.66% decrease in expected OOICU events.


Conclusions: The revised RRT activation criterion was associated with increased RRT usage and a decrease in OOICU cardiac arrests. This inverse relationship was both statistically and clinically meaningful, supporting the development and adoption of new clinical criteria for early detection and intervention of clinical deterioration.