Reflection on the Use of a Rapid Response Team and the Clinical Effectiveness of Early Warning Systems

I am writing in response to the article “Integration of Rapid Response Teams and Early Warning Systems to Reduce Cardiac Arrests and Intensive Care Unit Readmissions.”1 As a member of a growing rapid response team, I found this article to be an excellent summation of how an effective rapid response team can be proactively used to prevent patient decline.The use of an early warning system (EWS) is a crucial factor in how my team proactively identifies at-risk patients. The EWS scores are reviewed 3 times during a 12-hour shift and then as needed for patient follow-up and at the request of bedside staff. I also appreciated the attention Weigand et al brought to the importance of purposeful rounding on units. I have found that such rounding has been the most impactful tool in identifying at-risk patients early and developing rapport with bedside staff to facilitate a meaningful collaboration among care teams.A factor I plan to incorporate in my own practice is the quality measures used in this study to evaluate program outcomes. As identified in the article, continuous engagement of stakeholders is vital to the continued support of a rapid response team. The program outcomes chosen in the article highlighted the importance of a proactive team with critical care experience in preventing patient decline and readmission to the intensive care unit, thereby decreasing hospital length of stay.I would like clarification as to the number of high-acuity response team members used per shift during the quality improvement initiative described by Weigand and colleagues. Were there 1 or 2 nurses assigned per shift? Having 2 team members on each shift allows for a rapid assessment of the patient, along with simultaneous review of the patient’s chart and prior notes. The team can then identify the underlying issue, communicate effectively and clearly with providers, and facilitate rapid interventions that are both appropriate and patient specific.I suggest that additional projects be conducted to address the effectiveness of EWS as a predictor of patient decline. Did intensive care unit readmissions or rapid response calls correlate with the patient’s EWS score? My team uses the Epic Deterioration Index score, and we have spent a great deal of time reviewing the contributing weight of each factor to the score itself with our quality improvement team. The question that my team continues to evaluate is whether improved patient outcomes are the result of the EWS or the result of proactive rounding and mentorship/ education of the bedside staff.Thank you to the authors for your effort to continue emphasizing areas for growth and development. This article played a crucial role in highlighting the ongoing need for a rapid response team to enhance patient care and outcomes.