"Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems

Michael A. DeVita, Gary B. Smith, Sheila K. Adam, Inga Adams-Pizarro, Michael Buist, Rinaldo Bellomo, Robert Bonello, Erga Cerchiari, Barbara Farlow, Donna Goldsmith, Helen Haskell, Kenneth Hillman, Michael Howell, Marilyn Hravnak, Elizabeth A. Hunt, Andreas Hvarfner, John Kellett, Geoffrey K. Lighthall, Anne Lippert, Freddy K. LippertRazeen Mahroof, Jennifer S. Myers, Mark Rosen, Stuart Reynolds, Armando Rotondi, Francesca Rubulotta, Bradford Winters

Research output: Contribution to journalArticlepeer-review

234 Scopus citations


Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems? Results and conclusions: The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed.

Original languageEnglish (US)
Pages (from-to)375-382
Number of pages8
Issue number4
StatePublished - Apr 2010


  • Cardiac arrest
  • Critical care outreach
  • Medical emergency team
  • Monitoring
  • Patient safety
  • Rapid response system
  • Rapid response team
  • Resuscitation
  • Risk
  • Vital signs

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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