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Rapid response teams: a diagnostic dilemma
  1. Andre Carlos Kajdacsy-Balla Amaral1,2,
  2. Hannah Wunsch3,4
  1. 1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Anesthesiology, Columbia University, New York, New York, USA
  4. 4Department of Epidemiology, Columbia University, New York, New York, USA
  1. Correspondence to Dr Andre Carlos Kajdacsy-Balla Amaral, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Office D1 34, Toronto, ON, Canada M4N 3M5; andrecarlos.amaral{at}

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The implementation of rapid response teams (RRTs), also known as medical emergency teams, across the world has happened in parallel with the research to assess their effectiveness.1 The development of RRTs occurred due to observations that associated signs and symptoms are often present hours or days before clear clinical deterioration in the majority of patients.2 By assessing these patients early, RRTs would presumably prevent progression to cardiopulmonary arrest.

The article by Akhtar et al assesses the performance of a RRT in three NHS Acute Hospitals in England within a single NHS Trust, with a particular focus on the variability in duration and diagnostic accuracy of the call placed to trigger the RRT.3 Examining 426 RRT activations, the authors identified significant variation in the duration of the call placed, with the call taking anywhere from 6 s to 92 s. The authors then examined the recording to identify the causes of a longer call time, concluding that a substantial source of delay was confusion over whether to identify a situation as a medical emergency or a cardiac arrest. This leads to the question of whether RRTs should act separate from, or as an extension of, ‘code’ teams, which primarily focus on resuscitation of patients who have already had a cardiac arrest.

Early studies of RRTs focused on decreasing the frequency of cardiac arrests, suggesting that RRTs were originally created to only respond to a medical emergency before the onset of an arrest. Most of these data came from single-centre studies that used a ‘before–after’ design, comparing outcomes for the patients cared for before implementation of the RRT with outcomes …

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