[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Emergencies and life support](https://durgical.com/en/nursing/areas/emergency/) › Recognising deterioration and calling the rapid response team # 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. Updated Nov 5, 2026 ## Key points - Over 80% of in-hospital cardiac arrests have serious vital-sign abnormalities in the preceding 8 hours. - Rapid response system: detection criteria, a responding team and review to improve. - A high or rising early warning score means escalating under the protocol, without waiting. - Serious staff concern is on its own a valid criterion for calling. - Call with SBAR: Situation, Background, Assessment and Recommendation; read back the orders you receive. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/) ## Connections ## Related 2 - [Early warning scores (NEWS2) and when to escalate](https://durgical.com/en/nursing/early-warning-scores-and-when-to-escalate/) - [Basic life support from the nursing side](https://durgical.com/en/nursing/basic-life-support-from-the-nursing-side/) [← All of nursing](https://durgical.com/en/nursing/) 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](https://pmc.ncbi.nlm.nih.gov/articles/PMC2738303/) (Indian Journal of Critical Care Medicine (PubMed Central), 2008); [National Early Warning Score (NEWS) 2](https://www.rcp.ac.uk/improving-care/resources/national-early-warning-score-news-2/) (Royal College of Physicians, 2017); [Nursing Fundamentals, 2.4: Communicating with Health Care Team Members](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/02%3A_Communication/2.04%3A_Communicating_with_Health_Care_Team_Members) (Open RN, Chippewa Valley Technical College (LibreTexts), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/