Importance and implementation strategies of a rapid response team in non-critical hospital units: review and experience report of a philanthropic hospital
Importância e estratégias de implementação de um time de resposta rápida em unidades hospitalares não críticas: revisão e relato de experiência de um hospital filantrópico
Wilson Coelho Pereira Neto, Felipe Meirelles de Azevedo, Luciano Côrtes Paiva, Lucas dos Anjos Sena, Caroline Valle Americano, Deborah Gollner Evangelista, Daniel Angelo de Mattos, Thatiane Luci Freire, Susana Ribeiro Chaves Pinheiro, Eduardo da Silva Nascimento
Abstract
Background: In recent years, healthcare institutions have been dedicated to improving the quality of care and patient safety. However, adverse events are still common. In this context, the Rapid Response Team (RRT) emerges as a promising intervention to improve patient safety and enable early interventions. Aim: The objective of this study was to review research on the composition, activation criteria, and impact of RRTs in healthcare institutions, as well as to report the experience of implementing an RRT composed of a physiotherapist, physician, and nurse in a philanthropic hospital. Methods: This study was conducted using a combined methodology, which included a narrative review and an experience report. The review covered studies on the structure, activation criteria, and impact of RRTs. The experience report described the strategies implemented, such as quality indicators and technological tools. Results: In 2022, the RRT at the analyzed hospital conducted 3,586 calls, with 83.41% of patients remaining in the ward, 8.39% awaiting an ICU bed, and 6.78% being admitted to the ICU. Only 0.75% of cases resulted in death. These findings demonstrate a significant reduction in unplanned ICU transfers, highlighting the importance of early intervention. Conclusion: RRTs can improve hospital management and patient safety. Their implementation and adaptation to the local context are essential to ensure their effectiveness.
Keywords
Resumo
Introdução: Nos últimos anos, instituições de saúde têm se dedicado a aprimorar a qualidade assistencial e a segurança do paciente. No entanto, eventos adversos ainda são frequentes. Nesse contexto, o time de resposta rápida (TRR) surge como uma intervenção promissora para melhorar a segurança do paciente e possibilitar intervenções precoces. Objetivo: Revisar pesquisas sobre a composição, os critérios de ativação e o impacto dos TRRs em instituições de saúde, além de relatar a experiência da implementação de um TRR composto de fisioterapeuta, médico e enfermeiro em um hospital filantrópico. Métodos: Estudo conduzido com metodologia combinada, incluindo uma revisão narrativa e um relato de experiência. A revisão abordou estudos sobre a estrutura, os critérios de ativação e o impacto dos TRRs. O relato de experiência descreveu estratégias implementadas, como indicadores de qualidade e ferramentas tecnológicas. Resultados: Em 2022, o TRR do hospital analisado realizou 3.586 atendimentos, dentre os quais 83,41% dos pacientes permaneceram na enfermaria, 8,39% aguardaram leito de UTI e 6,78% foram admitidos na UTI. Apenas 0,75% dos casos resultaram em óbito. A implementação do TRR contribuiu para a redução significativa de transferências não planejadas para a UTI, melhorando a segurança do paciente. Conclusão: Os TRRs podem otimizar a gestão hospitalar e a segurança do paciente. Sua implementação e adaptação ao contexto local são fundamentais para garantir sua efetividade.
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Referências
1. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98(6):1388-92. https://doi.org/10.1378/ chest.98.6.1388. PMid:2245680.
2. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018;128:191-7. https:// doi.org/10.1016/j.resuscitation.2018.05.013. PMid:29777740.
3. Souza P, Serranheira F, Leite E, Nunes C, Uva AS. Eventos adversos em hospitais portugueses: estudo piloto de incidência, impacto e evitabilidade [Internet]. 1. ed. Lisboa: Escola Nacional de Saúde Pública, Universidade Nova de Lisboa; 2011 [citado em 2025 Fev 15]. 40 p. Disponível em: https://proqualis.fiocruz.br/livro/seguran%C3%A7a-do-doente-eventos-adversos-em-hospitaisportugueses-estudo-piloto-de-incid%C3%AAncia.
4. Andrade LS, Andrade AFSM, Torres RC, Teles WS, Silva MC, Silva MHS, et al. Perfil do enfermeiro frente a uma parada cardiorrespiratória no ambiente intra-hospitalar. Braz J Hea Rev. 2021;4(3):14305-16. https://doi.org/10.34119/ bjhrv4n3-361.
5. Kreindler SA, Cui Y, Metge CJ, Raynard M. Patient characteristics associated with longer emergency department stay: a rapid review. Emerg Med J. 2016;33(3):194-9. https:// doi.org/10.1136/emermed-2015-204913. PMid:26341654.
6. Murthy S, Leligdowicz A, Adhikari NK. Intensive care unit capacity in low-income countries: a systematic review. PLoS One. 2015;10(1):e0116949. https://doi.org/10.1371/ journal.pone.0116949. PMid:25617837.
7. Sirio CA. Clinical triggers or rapid response teams: does the emperor need “new” clothes? Jt Comm J Qual Patient Saf. 2009;35(3):162-3, 121. https://doi.org/10.1016/ S1553-7250(09)35021-7. PMid:19326808.
8. Lee A, Bishop G, Hillman KM, Daffurn K. The medical emergency team. Anaesth Intensive Care. 1995;23(2):183- 6. https://doi.org/10.1177/0310057X9502300210. PMid:7793590.
9. Girotra S, Jones PG, Peberdy MA, Vaughan-Sarrazin MS, Chan PS, Girotra S, et al. Association of rapid response teams with hospital mortality in medicare patients. Circ Cardiovasc Qual Outcomes. 2022;15(9):e008901. https://doi.org/10.1161/ CIRCOUTCOMES.122.008901. PMid:36065818.
10. Rocha HAL, Alcântara ACC, Borba FC No, Ibiapina FLP, Lopes LA, Rocha SGMO, et al. Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: quality in practice. Int J Qual Health Care. 2021;33(1):mzaa114. https://doi.org/10.1093/intqhc/ mzaa114. PMid:32991710.
11. Almeida MC, Portela MC, Paiva EP, Guimarães RR, Pereira WC No, Cardoso PR, et al. Implantação de um time de resposta rápida em um grande hospital filantrópico brasileiro: melhora na qualidade dos cuidados de emergência por meio do ciclo Planejar-Fazer-Estudar- Agir. Rev Bras Ter Intensiva. 2019;31(2):217-26. https:// doi.org/10.5935/0103-507X.20190036. PMid:31215601.
12. Schiøler T, Lipczak H, Pedersen BL, Mogensen TS, Bech KB, Stockmarr A, et al. Incidence of adverse events in hospitals: a retrospective study of medical records. Ugeskr Læger. 2001;163(39):5370-8. PMid:11590953.
13. Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19(1):254. https://doi.org/10.1186/s13054-015-0973-y. PMid:26070457.
14. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322(7285):517-9. https://doi.org/10.1136/ bmj.322.7285.517. PMid:11230064.
15. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The quality in australian health care study. Med J Aust. 1995;163(9):458-71. https://doi.org/10.5694/j.1326-5377.1995.tb124691.x. PMid:7476634.
16. Institute of Medicine. Committee on Quality of Health Care in America. To err is human: building a safer health system [Internet]. Washington, D.C.: National Academies Press; 2000 [citado em 2025 Fev 15]. Disponível em: https:// pubmed.ncbi.nlm.nih.gov/25077248/
17. Stahel PF, Fakler JKM, Flierl MA, Moldenhauer K, Mehler PS. Current concepts of patient safety: rapid response system. Unfallchirurg. 2010;113(3):239-46. https://doi.org/10.1007/ s00113-009-1734-7. PMid:20174916.
18. IHI: Institute for Healthcare Improvement. 10 IHI innovations to improve health and health care [Internet]. Cambridge: IHI; 2017 [citado em 2025 Fev 15]. Disponível em: https:// www.ihi.org/sites/default/files/10IHIInnovations.pdf
19. Hillman KM, Lilford R, Braithwaite J. Patient safety and rapid response systems. Med J Aust. 2014;201(11):654-6. https:// doi.org/10.5694/mja14.01260. PMid:25495310.
20. Brasil. Ministério da Saúde. Portaria nº 529, de 1º de abril de 2013. Dispõe sobre o programa nacional de segurança do paciente (PNSP). Diário Oficial da União [Internet]; Brasília; 2013 [citado em 2025 Fev 15]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/ prt0529_01_04_2013.html
21. Dias AO, Bernardes A, Chaves LDP, Sonobe HM, Grion CMC, Haddad MDCFL. Haddad MdO. Critical incidents as perceived by rapid response teams in emergency services. Rev Esc Enferm USP. 2020;54:e03595. https://doi.org/10.1590/ s1980-220x2018027903595. PMid:32813801.
22. Rincón-López JV, Larrotta-Castillo D, Estrada-Orozco K, Gaitán-Duarte H. Structure and roles of rapid response teams for adult care in high complexity hospitals: scoping review. Rev Colomb Obstet Ginecol. 2021;72(2):171-92. https://doi.org/10.18597/rcog.3671. PMid:34506704.
23. Rojas JC, Shappell C, Huber M. Advances in rapid response, patient monitoring, and recognition of and response to clinical deterioration. Jt Comm J Qual Patient Saf. 2017;43(12):686-94. https://doi.org/10.1016/j.jcjq.2017.10.001. PMid:29173290.
24. Boniatti MM, Loreto MS, Mazzutti G, Benedetto IG, John JF, Zorzi LA, et al. Association between time of day for rapid response team activation and mortality. J Crit Care. 2023;77:154353. https://doi.org/10.1016/j.jcrc.2023.154353. PMid:37311302.
25. Chalwin R, Giles L, Salter A, Eaton V, Kapitola K, Karnon J. Reasons for repeat rapid response team calls, and associations with in-hospital mortality. Jt Comm J Qual Patient Saf. 2019;45(4):268-75. https://doi.org/10.1016/j.jcjq.2018.10.005. PMid:30522833.
26. Pritchard AL, Chin KL, Story DA, Smart P, Jones DA, See E, et al. The epidemiology of rapid response team activation amongst patients undergoing major gastrointestinal surgery. Aust Crit Care. 2023;36(4):542-9. https:// doi.org/10.1016/j.aucc.2022.04.003. PMid:35613982.
27. Guirgis FW, Gerdik C, Wears RL, Williams DJ, Kalynych CJ, Sabato J, et al. Proactive rounding by the rapid response team reduces inpatient cardiac arrests. Resuscitation. 2013;84(12):1668- 73. https://doi.org/10.1016/j.resuscitation.2013.08.013. PMid:23994805.
28. Nelson JE, Mathews KS, Weissman DE, Brasel KJ, Campbell M, Curtis JR, et al. Integration of palliative care in the context of rapid response: a report from the Improving Palliative Care in the ICU advisory board. Chest. 2015;147(2):560-9. https:// doi.org/10.1378/chest.14-0993. PMid:25644909.
29. Jones D, Mitchell I, Hillman K, Story D. Defining clinical deterioration. Resuscitation. 2013;84(8):1029-34. https://doi.org/10.1016/j.resuscitation.2013.01.013. PMid:23376502.
30. Jones D, Moran J, Winters B, Welch J. The rapid response system and end-of-life care. Curr Opin Crit Care. 2013;19(6):616- 23. https://doi.org/10.1097/MCC.0b013e3283636be2. PMid:23799463.
31. Zimlichman E, Ehrenfeld M. The role of rapid response teams in end-of-life care. Jt Comm J Qual Patient Saf. 2018;44(9):503-4. https://doi.org/10.1016/j.jcjq.2018.06.003. PMid:30166033.
32. Braaten JS, deGunst G, Bilys K. Rapidly increasing rapid response team activation rates. Jt Comm J Qual Patient Saf. 2015;41(9):421-7. https://doi.org/10.1016/ S1553-7250(15)41054-2. PMid:26289237.
33. Olsen SL, Søreide E, Hillman K, Hansen BS. Succeeding with rapid response systems - a never-ending process: a systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS. Resuscitation. 2019;144:75-90. https:// doi.org/10.1016/j.resuscitation.2019.08.034. PMid:31525405.
34. Wood C, Chaboyer W, Carr P. How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. Int J Nurs Stud. 2019;94:166-78. https:// doi.org/10.1016/j.ijnurstu.2019.03.012. PMid:31002971.
35. Uppanisakorn S, Bhurayanontachai R, Boonyarat J, Kaewpradit J. National Early Warning Score (NEWS) at ICU discharge can predict early clinical deterioration after ICU transfer. J Crit Care. 2018;43:225-9. https:// doi.org/10.1016/j.jcrc.2017.09.008. PMid:28926736.
36. Whittington J, White R, Haig KM, Slock M. Using an automated risk assessment report to identify patients at risk for clinical deterioration. Jt Comm J Qual Patient Saf. 2007;33(9):569- 74. https://doi.org/10.1016/S1553-7250(07)33061-4. PMid:17915531.
37. Eddahchouri Y, Peelen RV, Koeneman M, Touw HRW, van Goor H, Bredie SJH. Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study. Br J Anaesth. 2022;128(5):857-63. https://doi.org/10.1016/j.bja.2022.01.036. PMid:35282866.
38. Xu MK, Dobson KG, Thabane L, Fox-Robichaud AE. Evaluating the effect of delayed activation of rapid response teams on patient outcomes: a systematic review protocol. Syst Rev. 2018;7(1):42. https://doi.org/10.1186/s13643-018-0705-x. PMid:29523180.
39. Niven DJ, Bastos JF, Stelfox HT. Critical care transition programs and the risk of readmission or death after discharge from an ICU: a systematic review and meta-analysis. Crit Care Med. 2014;42(1):179-87. https://doi.org/10.1097/ CCM.0b013e3182a272c0. PMid:23989177.
40. Zhang Q, Lee K, Mansor Z, Ismail I, Guo Y, Xiao Q, et al. Effects of a rapid response team on patient outcomes: a systematic review. Heart Lung. 2024;63:51-64. https:// doi.org/10.1016/j.hrtlng.2023.09.007. PMid:37774510.
41. Winters BD. Rapid response systems. Crit Care Clin. 2024;40(3):583-98. https://doi.org/10.1016/j.ccc.2024.03.008. PMid:38796229.
42. Glover G, Metaxa V, Ostermann M. Intensive care unit without walls. Crit Care Clin. 2024;40(3):549-60. https:// doi.org/10.1016/j.ccc.2024.03.002. PMid:38796227.
Submetido em:
15/02/2025
Aceito em:
08/01/2026
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