• Barbara-Ann Adelstein, Michael A Piza, Vineet Nayyar, Yugan Mudaliar, Peter L Klineberg, and George Rubin.
• Centre for Health Services and Workforce Research, Westmead Hospital, Sydney West Area Health Service, Australia.
• J Crit Care. 2011 Dec 1;26(6):635.e11-8.

PurposeThe purpose of the study was to evaluate the time taken for delivery of each component of care following patient deterioration and to assess the effect on response times of strategies implemented to improve the system.MethodsA model identifying the sequence of organizational responses following a patient's unexpected clinical deterioration was developed. The time to key events and interventions from initial deterioration was measured for 3 months in 2005 and again in 2006 at a tertiary care hospital with a rapid response team (RRT) in place. Strategies to improve compliance with the RRT system were introduced between the 2 periods.ResultsThe number of acute deterioration episodes identified increased (61 episodes in 2005; 154 episodes in 2006), but there was no improvement in response times. The 2 components contributing most frequently to delays were the time for nursing staff to call for assistance and, where needed, for physicians to call for higher-level care. Overall, 26% of episodes in 2006 and 30% in 2005 did not receive medical attention within 30 minutes of acute deterioration.ConclusionsSignificant delays in responding to acute deterioration persist despite strategies to facilitate the functioning of the RRT system. Simple strategies such as policy directives are not sufficient to effect change in complex health care systems.Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

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