Recognising deterioration and calling the rapid response team
- Safe practice
Almost every in-hospital arrest gives warning signs hours before: measuring them, seeing them and calling for help in time saves lives.
What it is
Most in-hospital cardiac arrests are preceded by serious abnormalities in vital signs in the hours before. A rapid response system has three parts: criteria to detect the patient at risk (vital signs, an early warning score and staff concern), a team with the skills to respond quickly, and case review to improve. Nursing is at the centre: it measures the signs, calculates the early warning score, recognises the change and calls for help. Communicating with SBAR makes the call clear and fast.
What it requires
- Measuring full sets of vital signs and level of consciousness, as often as ordered and at every change.
- Calculating the early warning score and following its response scale.
- Knowing your institution's activation criteria and the rapid response team's number.
- Structured communication (SBAR) and documentation of the call.
Components
- Physiological activation criteria (examples from a published system): RR below 5 or above 36/min; HR below 40 or above 140/min; SBP below 90 mmHg.
- A fall of more than 2 points on the Glasgow Coma Scale, repeated or prolonged seizures, or arrest.
- Any patient the staff are seriously worried about, even if no other criterion is met.
- Exact thresholds vary by institution: follow your protocol.
How it is applied (and why)
- Take a full set of vital signs and level of consciousness and compare them with the trend — the trend misleads less than one value.
- Calculate the early warning score — it turns several small changes into a level of risk and response.
- If the patient looks unwell or meets a criterion, stay with them and call for help — a deteriorating patient is not left alone.
- Activate the rapid response team under the protocol, without waiting for permission — delay worsens the outcome.
- While they come, act within your competence: airway, position, oxygen per protocol, monitor and crash cart nearby.
- Communicate with SBAR: situation, background, assessment and what you are asking for — an organised call is faster and clearer.
- Read back verbal orders to confirm them — avoids errors under pressure.
- Record the time, findings, whom you called, what was done and the patient's response — documents care and allows learning.
In nursing practice
- Situation: "I am [name], nurse on [unit]. I am calling about [patient, bed]: RR 30, falling saturation and confused."
- Background: admitting diagnosis, recent surgery or procedures, allergies, resuscitation status and recent results.
- Assessment: "I think the patient is deteriorating and may have a serious breathing problem."
- Recommendation: "I am asking you to see the patient now" (or within a set time) and what you expect to do meanwhile.
- Multi-tiered systems may have the ward nurse respond first and escalate if needed.
Common mistakes
- Waiting for the medical round when the patient already meets activation criteria.
- Normalising an abnormal value because "they are always like that", without checking the trend.
- Not calling for fear of bothering anyone: staff concern is an activation criterion.
- Calling without the vital signs, the score and the patient's information at hand.
- Not recording the call or the response.
Test yourself
Think of the answer, then tap the question to see it.
What share of in-hospital cardiac arrests show earlier warning signs in the vital signs?
Over 80% have serious vital-sign abnormalities in the 8 hours before the arrest.
Can you call the rapid response team if the patient meets no numerical criterion?
Yes. Staff being seriously worried about the patient is an activation criterion on its own.
What do the letters of SBAR stand for?
Situation, Background, Assessment and Recommendation or request. At the end, the orders received are read back.
What are the three parts of a rapid response system?
Criteria to detect the patient at risk, a skilled team that responds quickly, and case review to improve quality.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Rapid response systems (Indian Journal of Critical Care Medicine (PubMed Central), 2008); National Early Warning Score (NEWS) 2 (Royal College of Physicians, 2017); Nursing Fundamentals, 2.4: Communicating with Health Care Team Members (Open RN, Chippewa Valley Technical College (LibreTexts), 2021).
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Representative model, for educational purposes only.