Barriers to activation of the rapid response system

Resuscitation. 2014 Nov;85(11):1557-61. doi: 10.1016/j.resuscitation.2014.07.013. Epub 2014 Aug 7.


Background: The rapid response system (RRS) has been widely implemented in the US. Despite efforts to encourage activation of the RRS, adherence to activation criteria remains suboptimal. Barriers to adherence to RRS activation criteria remains poorly understood.

Objective: To identify barriers associated to activation of the RRS system by clinical staff.

Methods: Physicians and nurses on the medical and surgical wards of a New York City community hospital were surveyed to identify barriers to six criteria for activation of the RRS. A paper questionnaire was disseminated. We assessed familiarity with, agreement with, and recognition of perceived benefit of the RRS calling criteria using a Likert scale. Self-reported adherence to RRS activation was also measured on a Likert scale. Logistic regression was used to assess the association between the barriers and the six RRS criteria.

Results: Sixty eight physicians and 16 nurses completed the survey; response rates were 59% and 35%, respectively. Self-reported adherence rate was ≤25% for the six criteria. We observed that as the familiarity with, agreement with, and perceived benefit of activating the RRS increases, the self-reported adherence also increases.

Conclusions: Adherence to activation of RRT based on the six criteria measured is low. As familiarity with, agreement with, and perceived benefit of the RRS activating criteria rise, self-reported adherence rates increase, with familiarity having the greatest impact. These results can be used to develop tailored interventions to increase adherence to RRT activation in health care institutions.

Keywords: Activation barriers; Afferent limb failure; Medical emergency team; Physician and nurse attitudes, Knowledge and behavior; Rapid response system.

Publication types

  • Comparative Study

MeSH terms

  • Analysis of Variance
  • Attitude of Health Personnel*
  • Communication Barriers
  • Confidence Intervals
  • Critical Care / organization & administration
  • Emergency Service, Hospital / organization & administration
  • Female
  • Health Care Surveys
  • Hospital Rapid Response Team / organization & administration*
  • Hospitals, Urban
  • Humans
  • Intensive Care Units
  • Interdisciplinary Communication*
  • Logistic Models
  • Male
  • Needs Assessment
  • New York City
  • Patient Care Team / organization & administration
  • Quality of Health Care*
  • Surveys and Questionnaires*