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Continuously improving patient safety by a rapid response system


Resulting from the Dutch VMS Safety Program 'Prevent injury, work safely', we recently started to implement a rapid response system (RRS) in our hospital. The RRS consists of: a warning signs pocket card, a Rapid Response Team (RRT) and an evaluation system. The purpose of the RRS is to recognize and treat the patients with clinical warning signs early on the ward to reduce preventable hospital-wide avoidable injury. We present the first results of the implementation of the RRS.


Data regarding the RRT calls and the evaluations were collected from 1 May 2008 until 30 April 2009 (total: 114 calls). We were interested in: the cause of the RRT call, the results of the call and the advice following the evaluation of the calls.


The main reasons for the calls were respiratory failure (47%), hemodynamic problems (31%), neurological problems (7%) or a combination of problems in 15%. In 45% of the calls the patient was admitted to the ICU, medium care unit (MCU) or cardiac care unit (CCU). In 55% of the calls the patient stayed on the ward. During the call 14% of the patients who stayed on the ward obtained a do-not-resuscitate or a do-not-transfer-to-the-ICU order. These decisions were always taken in close cooperation with the doctor taking care of the patient on the ward. Evaluations were performed in 76% of the calls. In 45% of the calls the warning signs were recognized in time. Problems identified were late identification of clinical deterioration of the patient (30%) and failure to treat to a patient with clinical warning signs due to failures in planning (6%) or communication (26%).


In 45% of the RRT calls, transfer of the patient to the ICU/MCU/CCU is required. Hospital-wide improvement initiatives should focus on: timely recognition of clinical deterioration of the patient; failures in planning and communication; and timely agreed restrictive measurements on the ward.

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Correspondence to V Van Bruggen.

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Van Bruggen, V., Barendrecht, P., Geense, A. et al. Continuously improving patient safety by a rapid response system. Crit Care 14, P261 (2010).

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  • Respiratory Failure
  • Patient Safety
  • Warning Sign
  • Clinical Deterioration
  • Prevent Injury