Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, DNSc, RN, FAAN, Chairperson; Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN; Kathleen M. Stacy, PhD, RN, APRN-CNS, CCNS


Rapid response team, medical emergency team, clinical deterioration, delay in activation, resuscitation, mortality


Purpose: The purpose of the dissertation study was to determine the difference in survival and length of stay (LOS) between patients who experienced a delay in Rapid Response System (RRS) activation and those patients who had no delay.

Rationale: There is evidence to support that the RRS is often not activated in a timely manner potentially leading to negative patient outcomes.

Background: Delaying treatment for in-hospital clinical deterioration has been associated with Serious Adverse Events (SAEs), including increased mortality, protracted LOS during hospitalization, and significant increased financial costs. The RRS was created as a hospital-wide approach to prevent SAEs; however, there are often delays in activation of the system.

Findings: During the study period, 1,086 RRS activations occurred. Delayed RRS activations occurred in 325 cases and non-delayed RRS activations occurred in 766 cases. Eighty-five percent of patients survived hospitalization regardless of experiencing a delay or not. Delay in RRS activation was significantly associated with an increase in length of hospitalization and a higher likelihood of not surviving hospitalization.

Implications: Nurses play an important role in the early detection and intervention of clinical deterioration and are commonly the first health care providers to notice a change in a patient’s condition. This study confirms that delayed RRS activation occurs frequently and exposes patients to increased LOS and mortality during hospitalization. Given these findings, targeting nursing interventions for early identification and timely activation of the RRS can improve patient outcomes.

Document Type

Dissertation: Open Access