Rapid Response Teams in low and middle-income countries: a scoping review

TL;DR

This paper reviews how Rapid Response Teams are used in low and middle-income countries to help patients whose health is worsening, finding limited evidence and a need for more research.

Contribution

The study provides the first comprehensive scoping review of Rapid Response Teams in low- and middle-income countries, highlighting gaps in evidence and implementation.

Findings

Most studies on Rapid Response Teams in low- and middle-income countries come from Brazil, India, and Turkey.

The majority of studies focused on mortality and code blue incidence as outcomes.

Evidence on Rapid Response Teams in these settings is limited and lags behind high-income countries.

Abstract

Rapid Response Teams have been widely implemented in high-income countries and play a crucial role in the early identification and management of clinically deteriorating patients. However, their implementation in low and middle-income settings has not been adequately described. Our goal was to map the current evidence in this setting.

We conducted a scoping review to map the published literature about Rapid Response Teams in low- and middle-income countries, according to year of publication, study type, team composition, reported outcomes, and potential roles of the team.

After screening 6,679 studies, 52 fulfilled eligibility criteria: 36 full-text studies and 16 conference abstracts. Most of the studies were from Brazil (51.2%), followed by India (19.2%) and Turkey (7.7%), with the two earliest reports being conference abstracts published in 2009. The predominant design was before-and-after studies (20; 38.4%), followed by cohort studies (16; 30.8%). An intensive care unit physician was always a member of the Rapid Response Teams in 55.9% of the studies and an intensive care unit nurse in 23.5%. The number of Rapid Response Teams calls in the before-and-after studies ranged from 2.39 to 124 per 1,000 admissions. Reported outcomes varied, with most studies focusing on mortality (26, 50%) and code blue incidence (21; 40.4%). Four (7.7%) studies reported an active role of Rapid Response Teams in goals of care discussions.

We found that evidence on Rapid Response Teams in low- and middle-income countries remains limited, with a time lag in publications compared to high-income countries. Our findings highlight the need for further studies and policy initiatives to evaluate the effectiveness of implementing Rapid Response Teams in resource-constrained settings.

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