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  • Historic studies identified that patients admitted to hospital develop serious adverse events (SAEs) in up to 20% of admissions. In addition, hospitalized patients can deteriorate unexpectedly due to the development of a new problem.

  • In a high percentage of cases, deterioration was gradual in onset and associated with the development of derangement in the patient’s vital signs.

  • Many hospitals have introduced Rapid Response Teams (RRTs) to review deteriorating patients when they develop derangements in vital signs that fulfill predefined criteria.

  • Evidence for the effectiveness of RRTs has been shown in four systematic reviews.

  • The optimal team composition and thresholds for activation remain undetermined.


Modern hospitals treat patients with increasingly complex medical conditions. Despite advances in medical technology and the advent of new medicines and interventions, many patients admitted to hospitals suffer adverse events. The most studied of these events are unplanned admissions to the intensive care unit (ICU), unexpected hospital deaths, and cardiac arrests. Historic studies revealed that such events are preceded by the development of new problems or derangements in vital signs for several hours and that the response to these problems by ward staff may be suboptimal.

Traditional code teams are activated when a patient suffers a cardiac arrest manifesting as a loss of circulation or respiration. Such events are associated with a high in-hospital mortality. In this chapter, we discuss the concept of the Rapid Response Team (RRT), which is activated when a patient develops less severe and earlier signs of instability than seen during cardiac arrests. We also describe the Rapid Response System (RRS), which is the entire system used to support the team.


Modern hospitals in developed countries care for patients of increasing age, acuity, and complexity.1 Studies conducted in North America, Australia, New Zealand, and the United Kingdom during the 1990s and early 2000s suggested that such patients suffer adverse events in up to 20% of cases depending on the definition used and population assessed (Table 12-1).

TABLE 12-1Summary of Studies Reporting Adverse Events in Hospitalized Patients

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