Tiered Rapid Response Systems

Tiered rapid response systems (RRSs) support graded escalation of, and response to, deteriorating ward patients in hospital. Within tiered RRSs, the type of clinical response varies according to the severity of the patient’s physiological abnormalities. Mild physiological abnormalities are expected to trigger an urgent pre-rapid response team (pre-RRT) review conducted by the patient’s usual care providers such as senior ward nurses and/or doctors. In contrast, severe physiological abnormalities are expected to trigger emergency assistance by specialist critical care clinicians in the form of an RRT review. Thus, tiered RRSs promote early detection of patient deterioration and enable allocation of hospital resources to be matched to patient acuity. It is anticipated that intervention during the pre-RRT period will prevent the progression to severe physiological abnormalities requiring RRT review, thereby optimising patient outcomes. Prominent examples of tiered RRSs include the National Early Warning Score from the UK and tiered single-parameter RRSs from Australia. The purpose of this chapter is to provide an overview of tiered RRSs with regard to their purpose and design, evidence for use, and associated implementation challenges, with a particular focus on pre-RRT triggers and interventions.