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Development and Pragmatic Evaluation of a Rapid Response Team

Elliott, Rosalind PhD, RN; Martyn, Louise RN; Woodbridge, Sarah RN; Fry, Margaret PhD, RN; Foot, Carole MD; Hickson, Liz MD

doi: 10.1097/CNQ.0000000000000263
Original Articles

In response to national and local drivers, a clinical emergency response system (CERS) incorporating an intensivist-led rapid response team (RRT) was implemented at a Sydney (Australia) hospital. The authors present a pragmatic evaluation of the 5 years since this major initiative was commenced. A “partner not conquer” philosophy was adopted. Implementation of the RRT was based on a collaborative pragmatic quality improvement approach. A team of intensive care specialist trained medical doctors (n = 2) and clinical nurse consultants (n = 2) set up the service with executive support and funding. Roles and responsibilities were clearly detailed, reinforcing a positive, partnership-driven culture. A constantly evolving education strategy was a critical element of implementation and maintenance. Ongoing evaluation includes process and patient outcome data. Serious patient deterioration-related incidents have decreased significantly (from 7 to 1 per year) and the RRT has been universally accepted by clinicians. Key lessons learned include the need for specific protected funding, a partnership approach ensuring hospital clinicians retain responsibility of patient treatment, ongoing education and reinforcement, and strong nursing leadership. However, generalizations cannot be made about the implementation of the CERS. It is important to consider context; “one size does not fit all.”

Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia (Drs Elliott, Fry, Foot, and Hickson and Mss Martyn and Woodbridge); and Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia (Drs Elliott and Fry).

Correspondence: Rosalind Elliott, PhD, RN, Department of Intensive Care, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia (

The authors acknowledge the hard work and commitment of the hospital executive and clinicians to ensure the effective implementation and sustainability of the rapid response service.

Funding for the service is provided by Northern Sydney Local Health District (New South Wales Ministry of Health, Australia).

The authors declare that they have no conflict of interests in relation to the content of this article.

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