BMJ Qual Saf doi:10.1136/bmjqs-2011-000390
  • Original research

Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators

  1. Leora I Horwitz1,3
  1. 1Department of Performance Management, Yale New Haven Health System, New Haven, Connecticut, USA
  2. 2Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Andrea L Benin, System Executive Director, Performance Management, Yale New Haven Health, Associate Research Scientist, Pediatrics, Yale School of Medicine, 789 Howard Avenue (300 George St #487), Performance Management, 4th floor, New Haven, CT 06519, USA; andrea.benin{at}
  1. Contributors All authors participated in the conception and design, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.

  • Accepted 1 January 2012
  • Published Online First 2 March 2012


Objective The objective of this study was to qualitatively describe the impact of a Rapid Response Team (RRT) at a 944-bed, university-affiliated hospital.

Methods We analysed 49 open-ended interviews with administrators, primary team attending physicians, trainees, RRT attending hospitalists, staff nurses, nurses and respiratory technicians.

Results Themes elicited were categorised into the domains of (1) morale and teamwork, (2) education, (3) workload, (4) patient care, and (5) hospital administration. Positive implications beyond improved care for acutely ill patients were: increased morale and empowerment among nurses, real-time redistribution of workload for nurses (reducing neglect of non-acutely ill patients during emergencies), and immediate access to expert help. Negative implications were: increased tensions between nurses and physician teams, a burden on hospitalist RRT members, and reduced autonomy for trainees.

Conclusions The RRT provides advantages that extend well beyond a reduction in rates of transfers to intensive care units or codes but are balanced by certain disadvantages. The potential impact from these multiple sources should be evaluated to understand the utility of any RRT programme.


  • Funding During the period of the study, Dr Benin was supported by the National Library of Medicine (grant number 5K22LM9142) and Dr Horwitz was supported by grant number UL1 RR024139 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Dr Horwitz is currently supported by the National Institute on Ageing and the American Federation for Ageing Research (K08 AG038336).

  • Competing interests None of the authors have any affiliation, financial agreement or other involvement with any company whose product figures prominently in the submitted manuscript.

  • Ethics approval Yale School of Medicine Human Investigations Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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