IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20180101 536 VIEWPOINT International Journal of Cardiovascular Sciences. 2019;32(5):536-539 Mailing Address: Viviane Cordeiro Veiga Rua Martiniano de Carvalho, 864, Cj 310. Postal Code: 01321-000, Paraíso, SP - Brazil. E-mail: dveiga@uol.com.br , vcveiga@cardiol.br Performance of the Rapid Response Systems in Health Care Improvement: Benefits and Perspectives Viviane Cordeiro Veig a a nd Salomón Soriano Ordinola Roja s Hospital BP - A Beneficência Portuguesa de São Paulo, SP - Brazil Manuscript received December 29, 2017; revised manuscript July 31, 2018; accepted August 07, 2018. Hospital Rapid Response Team; Patient Safety; Patient Care Team; Hospital Mortality. Keywords Introduction In the last two decades, the rapid response systems (RRS) have been explored as initiatives to increase the safety of hospitalized patients. The main function is to identify and treat patients at risk, or who are presenting signs of clinical instability, and to prevent adverse events during hospital stay, with a consequent reduction in in-hospital mortality. Every year in the United States, more than 200,000 intrahospital cardiac arrests (CAs) occur, most of which could be avoided. 1 RRS are formed by two health care components called the afferent limb and the efferent limb. 2 The afferent limb is represented by the health care team in the admission units, responsible for the care of hospitalized patients and trained to activate the afferent limb, when physiological changes that predict adverse events are detected, especially cardiac arrests. The efferent limb is represented by a team of health care professionals, who respond to codes, and may be headed by a physician, a nurse or a physiotherapist. The efferent limb is better known as the rapid response team (RRT). In addition to these health care components, the rapid response systems must also have two other components, namely the administrative arm, which provides the necessary documentation and is responsible for the systems daily activities and the quality and governance arm, which contributes to continuous improvement and reassessment of the system. These systems have been implemented around the globe, but still in a non-uniform way in institutions and health systems with different characteristics. However, in Brazil, there are few reports on this issue. 3,4 Activating criteria Failure in the early detection of clinical deterioration signs are frequent in the health institutions associated with the worst outcomes and increased hospital costs. 5 RRS activation criteria are based, mainly, on changes in vital signs, which are routinely monitored in the hospitalization units. Schein et al. 6 , in 1990, studied the presence of clinical deterioration signs in the 24 hours prior to CA. Among the 64 patients evaluated, 54 (84%) presented at least one change in the clinical parameters during the eight hours that preceded the event. In order to develop objective criteria for RRS activation, Franklin and Mathew 7 described the changes which preceded CA: mean blood pressure lower than 70 mmHg, mean blood pressure higher than 130 mmHg, heart rate lower than 45 bpm, heart rate higher than 125 bpm, respiration rate under 10 bpm, respiration rate over 30 bpm, change in the level of consciousness and chest pain. Veiga 3 , on a case-by-case national basis, describes the results related with the changes in activation criteria, considering the epidemiological characteristics of the institution and maturity after 18 months of RRT. The RRT activation criteria described in the study that presented better results were: code blue (cardiac arrest); code yellow: heart rate less than 50 or more than 110 bpm; systolic blood pressure less than 90 or higher than 180 mmHg, with symptoms, respiratory rate under 10 or over 24 breaths/minute, decreased level of consciousness and/or sudden motor deficit, acute decrease of O 2 saturation to < 90%, seizures, acute bleeding and active screening for sepsis. However, there are major weaknesses in vital signs measurement, both in relation to the frequency of data collection and even in relation to their assessment confidence level, especially concerning the respiration rate. 8,9 Failure in recognizing unstable patients leads to