Afferent Limb of Rapid Response System Activation

Fundamental to the implementation of a functional rapid response system for the treatment of hospitalized patients is the identification of instability by the bedside caregivers who must activate the alert. This afferent limb of the rapid response system has the primary goal of crisis detection and is, therefore, the essential first element of effective rapid response system operations. More specifically, its purpose is the early recognition of ‘emergent unmet patient needs’, defined as mismatches between the care a patient is receiving and the care that patient immediately requires [1]. The afferent limb has the unique challenge of moving from its inception point, characterized by the clinical surveillance of all hospital inpatients during their admission, to its distinct endpoint of efferent limb activation of a rescue response for specific patients at specific times during their hospital stay. It may even be speculated that the inability for any trial to demonstrate that the application of a rapid response system definitively decreases mortality [2] may lie with failures to adequately monitor patients for instability, recognize instability once it occurs, and decide to make the call to escalate care — all components of the rapid response system afferent arm. In order to meet this challenge to safely and effectively rescue unstable patients, those wishing to design and maintain a timely, effective and efficient afferent limb of a rapid response system must address three components.