Introduction: Failure to recognize and act on clinical deterioration remains a key contributor to morbidity and mortality in hospitalized patients. We hypothesized that a structured, institution-wide review of Rapid Response (RR) and Cardiac Arrest (CA) activations would identify actionable gaps in escalation practices and inform system-level interventions.
Methods: We performed a retrospective review of all RR (n=119) and CA (n=93) activations at a community hospital in the Bronx from July 2024 to July 2025. Standardized RR/CA documentation and EMR chart review were used to extract clinical variables. Descriptive statistics and trend analyses were used to identify patterns and escalation gaps.
Results: Over a 12-month period, 119 RRs and 93 CAs were analyzed. 59.6% of RRs occurred during the day shift, without evidence of unit clustering or a direct association between RR activation and shift change. Only 31% of RRs were initiated by nurses. A separate nursing survey revealed that 100% of nurses felt confident and knew the criteria for activating a RR; however, 45% of nurses worried about calling a rapid response unnecessarily. The most common triggers for RRs were altered mental status (33%) and respiratory failure (25%). Among the 93 CAs, only 6 cases (6.45%) had a preceding RR called. The initial rhythm was pulseless electrical activity in 58% of cases, 29% asystole and 0.097% had a shockable rhythm. Of the CAs, 9 had shockable rhythms with a 44.4% ROSC rate. The remaining 84 non-shockable rhythms had a 58.3% ROSC rate. ROSC was achieved in 48% of CAs. Overall survival to discharge was 2.1%.
Conclusions: This 12-month review of RRs and CAs underscores the need for targeted interventions to identify patients at risk for decompensation. Early recognition of clinical decline can be augmented using the Modified Early Warning Score (MEWS) scoring system within the EMR to support real-time risk stratification and earlier escalation. Furthermore, our nursing survey results suggests a need to encourage nursing staff to activate a RR. Implementing an electronic scoring system to send an alert when higher level of care is warranted along with encouraging all staff to call a rapid response may help prevent future cardiac arrests.
