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‘Between the flags’: implementing a rapid response system at scale
  1. Clifford Hughes1,
  2. Charles Pain2,
  3. Jeffrey Braithwaite3,
  4. Kenneth Hillman4
  1. 1Clinical Excellence Commission, Sydney, Australia
  2. 2Health Systems Improvement, Clinical Excellence Commission, Sydney, Australia
  3. 3Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
  4. 4Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia
  1. Correspondence to Professor Jeffrey Braithwaite, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; j.braithwaite{at}


While many hospitals are implementing rapid response systems (RRSs) to attend to deteriorating patients in a systematic way, there is little documented evidence on system-wide approaches to adopting RRSs. Here, we report on an initiative which enrolled 220 hospitals in New South Wales, Australia. The ‘between the flags’ approach was modelled on Australia's surf lifesaving experience, where qualified lifesavers perform thousands of rescues each year. Patients in hospitals who are identified as being ‘between the flags’ are given special attention, just like beach goers.

  • Patient Safety
  • Implementation Science
  • Health Policy
  • Medical Emergency Team
  • Risk Management

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