Rapid response systems and the culture of safety

Rapid response systems were implemented because of the high incidence of potentially preventable deaths in hospitals. This problem arose, in part, from suboptimal patient management on the general floors of acute hospitals predicated on cultural factors such as lack of cooperation between and within teams, rigid hierarchical structures and triaging systems, and patient variables, namely increase in patient age, frailty and comorbidities. In this chapter, we unpack organisational culture and its implications for rapid response systems including the historical role of culture in the need for a hospital rapid response system, how hospital culture is assessed, influence of culture on the adoption of a rapid response system and, reciprocally, understanding the impact of a rapid response system on culture. Within this paradigm, important considerations are staff adherence to established power structures, individual empowerment to detect patient deterioration and intervene, how effectively the various silos in a hospital work together and access to supportive leadership and adequate education. Looking forward, we discuss issues surrounding the utilisation of rapid response systems for patients who have end-of-life challenges and the need to broaden our approach to what constitutes potentially serious adverse events for end-of-life care.