Abstract

There is a growing interest about the implementation of specialised teams operating in the hospital setting, which as main goals have the early identification, review and treatment of unstable ward patients, ie, outside intensive care units (ICU), in their early phase of deterioration, to prevent cardiac arrest.

These teams are variably named as rapid response teams (RRT), medical emergency teams or clinical care outreach teams. They have recently been introduced in some hospitals in the UK, Australia and the USA, as part of early warning systems, with the assumption that early intervention may improve outcome in unstable patients. In fact, serious adverse events and cardiopulmonary arrests are often preceded by derangements of vital parameters or biochemical markers, which may be detected and dealt with several hours before acute deterioration. Generally, the RRT can be activated by any staff member working in units outside the ICU setting, according to predefined criteria that are mainly based on derangements of vital parameters, such as acute change in respiratory or heart rate, oxygen saturation, blood pressure or level of consciousness.

RRT are usually multidisciplinary teams, typically composed of ICU physicians, ICU nurses, ICU respiratory therapists, emergency physicians and emergency nurses, according to local organisation and human resources availability.

Although some evidence is accumulating in the adult population, showing a potential benefit of RRT in reducing codes and mortality in non-ICU patients, available data evaluating the effectiveness of RRT implementation in paediatric inpatients are still limited. Indeed, similar to adults, paediatric inpatients may exhibit physiological deterioration for several hours before cardiopulmonary arrest. Early recognition could thus allow a prompt intervention and reduce the risk of further deterioration leading to cardiopulmonary arrest also in this population.