Development and Pragmatic Evaluation of a Rapid Response Team

In response to national and local drivers, a clinical emergency response system (CERS) incorporating an intensivist-led rapid response team (RRT) was implemented at a Sydney (Australia) hospital. The authors present a pragmatic evaluation of the 5 years since this major initiative was commenced. A "partner not conquer" philosophy was adopted. Implementation of the RRT was based on a collaborative pragmatic quality improvement approach. A team of intensive care specialist trained medical doctors (n = 2) and clinical nurse consultants (n = 2) set up the service with executive support and funding. Roles and responsibilities were clearly detailed, reinforcing a positive, partnership-driven culture. A constantly evolving education strategy was a critical element of implementation and maintenance. Ongoing evaluation includes process and patient outcome data. Serious patient deterioration-related incidents have decreased significantly (from 7 to 1 per year) and the RRT has been universally accepted by clinicians. Key lessons learned include the need for specific protected funding, a partnership approach ensuring hospital clinicians retain responsibility of patient treatment, ongoing education and reinforcement, and strong nursing leadership. However, generalizations cannot be made about the implementation of the CERS. It is important to consider context; "one size does not fit all."