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Original Article
Rapid response system Resident and nurse attitudes toward a rapid response team in a tertiary hospital in South Korea
Sung Yoon Lim1,*orcid, Ho Geol Woo2,*orcid, Jong Sun Park1orcid, Young-Jae Cho1orcid, Jae Ho Lee1orcid, Yeon Joo Lee1orcid
Acute and Critical Care 2025;40(1):29-37.
DOI: https://doi.org/10.4266/acc.004272
Published online: February 12, 2025

1Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

2Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea

Corresponding author: Yeon Joo Lee Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7082, Fax: +82-31-787-4052, Email: yjlee1117@snubh.org
*These authors contributed equally to this work as co-first authors.
• Received: November 7, 2024   • Revised: December 4, 2024   • Accepted: December 4, 2024

© 2025 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    Residents and nurses who activate rapid response teams (RRTs) are well positioned to offer insights on its effectiveness. Here, we assess such evaluation of RRTs and identify barriers to activation in a 1,400-bed teaching hospital.
  • Methods
    We conducted a 24-item Likert-scale survey from January to May 2017 among residents and ward nurses with RRT experience. Factor analysis was used to identify the barriers.
  • Results
    This study comprised 305 nurses and 53 residents, most of whom were satisfied with their RRT experiences. Factor analysis showed that lack of awareness of activation criteria was a major barrier, with only 21.4% and 22.2% participants, respectively, confident about their knowledge of activation protocols. Of the survey respondents, 85.7% reported first contacting the doctor before activating the RRT. Despite the protocol, 66.7% first discussed the decision with other staff, and 71.5% called the RRT when the patient’s condition worsened despite management.
  • Conclusions
    Nurses and residents value RRTs but face barriers in initiation, primarily due to a lack of confidence in applying the activation criteria. Many prefer to consult a doctor or manage the patient before calling the RRT.
  • Key Words: attitude; clinical deterioration; hospital rapid response team; nurse; survey
Clinicians frequently manage multiple hospitalized patients simultaneously and may overlook early warning signs preceding clinical worsening. Hospitalized patients may unexpectedly deteriorate and require admission to an intensive care unit (ICU), which can result in severe morbidity and mortality, including cardiac arrest [1,2]. Previous studies have shown that the rate of clinical deterioration can be as high as 18%, even in countries with advanced healthcare systems [3]. However, half of these deteriorations are often preventable. If identified promptly, clinical deterioration can be mitigated through simple interventions [4].
The rapid response team (RRT) is a group of healthcare providers who respond early to hospitalized patients experiencing unexpected clinical deterioration, provide necessary management at the bedside, and help prevent sudden in-hospital cardiac arrest [5]. An RRT is designed to be activated when hospitalized patients exhibit changes in their mental status, hemodynamic instability, or respiratory compromise [6]. Patients identified by the RRT can receive immediate and appropriate interventions, including medical treatment and/or transfer to the ICU, at an earlier stage of clinical deterioration. We previously showed that a part-time rapid response system (RRS) at a tertiary teaching hospital reduced the incidence of cardiopulmonary arrest [7]. Since 2005, these teams have been widely used at several global hospitals to improve patient safety.
However, a randomized prospective controlled trial of RRTs in 23 Australian hospitals failed to show improved outcomes [8]. A post hoc analysis showed that half of the patients with cardiac arrest experienced prior documented RRT use criteria, but the RRT was not activated [9]. In South Korea, an RRT is primarily activated by residents and nurses providing primary care to hospitalized patients, and people in such positions are suited to offer valuable insights into the effectiveness and limitations of RRT. This study aimed to assess the perceptions of residents and nurses regarding RRT services and to evaluate the factors contributing to delayed activation of RRT by residents and nurses in a tertiary teaching hospital.
The study adhered to the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of Seoul National University Bundang Hospital (No. B-1410-272-005). Survey respondents included residents trained at a tertiary teaching hospital and registered nurses in the general ward with experience in RRT coverage. Participation in the study was voluntary and anonymous. All participants provided written informed consent before they were asked to answer the questionnaire.
RRT Team and Target Population
A prospective survey was conducted between January and May 2017 at a tertiary teaching hospital. RRTs have been operational in tertiary teaching hospitals in Korea since October 2012, with active periods of 7 AM to 10 PM on weekdays and 7 AM to 12 AM on Saturdays. Each RRT team comprises four nurses each with more than 5 years of ICU experience and 12 intensivists from a variety of backgrounds, including internal medicine, anesthesiology, emergency medicine, and thoracic surgery. From 7 AM to 6 PM on weekdays at the studied hospital, two designated nurses, one pulmonologist (an intensivist in charge of the medical ICU), and one anesthesiologist (an intensivist in charge of the surgical ICU) were on RRT duty. From 6 PM to 10 PM on weekdays and from 7 AM to 12 AM. on Saturdays, one of the 12 doctors on rotating duty and two nurses were on RRT duty, as described in our previous report [7]. An RRT can be activated by two primary mechanisms: a direct call from nurses and residents who provide primary care to hospitalized patients and an electronic medical record (EMR) screening system that uses 10 criteria (Supplementary Table 1) to identify patients at risk of clinical deterioration.
Instruments and Measures
We modified a previously developed and validated questionnaire for RRT services using an expert consensus approach and translated it into Korean [10-12]. The questionnaire consisted of 24 items, each containing five Likert response options ranging from “strongly agree” to “strongly disagree.” The survey consisted of two main parts: the first broadly assessed level of satisfaction with RRT services, and the second was designed to identify obstacles to activating the RRT system. An open-ended question was included to allow participants to provide additional comments or suggestions for improving the activation protocol (Supplementary Tables 2 and 3). The questionnaire was randomly distributed to nurses and residents in the general ward covered by the RRT, and they were requested to return it within 3 weeks.
Statistical Analysis
Data from the questionnaire responses were reported as means, standard deviations, frequencies, and proportions. The reliability of the questionnaire was assessed using the Cronbach α coefficient. Exploratory factor analysis was used to identify the main barriers to RRT activation. Factors were extracted using the principal axis factoring method, and varimax rotation was applied to clearly separate factors and optimize interpretability. The sum of the scores for each factor’s associated questions was computed. In addition, we conducted subgroup analyses by professional group (nurses and residents). Normality of the data was tested using the Kolmogorov-Smirnov test. Spearman’s and Pearson’s correlation coefficients were applied to assess the associations between factor components and continuous variables. All statistical analyses were performed in IBM SPSS version 19.0 (IBM Corp.), and a two-tailed P-value <0.05 was considered statistically significant.
From January to May 2017, nurses and residents agreed to participate in this study, and 358 questionnaires were received (response rate, 95.47%), 305 from ward nurses and 53 from residents (Figure 1). The proportions of RRT activation by EMR screening and staff determination were 70.0% and 30.0%, respectively.
Satisfaction with the RRT among Residents and Nurses
A summary of the responses to the questionnaire on satisfaction is presented in Table 1 and Figure 2. Most residents and nurses (84.4%) agreed or strongly agreed that RRT services can prevent a minor problem from becoming a large problem (item 7), and 93.0% reported that such services can hinder cardiac and respiratory arrests (item 1). Most respondents (82.1%) agreed or strongly agreed that an RRT service was helpful in managing patients (item 6), and 93.8% reported that it helps staff to seek assistance when wanted (item 8). Most respondents (77.1%) also agreed or strongly agreed that the RRT contributed to their knowledge of acute patient care (item 5), and 72.2% reported that RRT experience improved their skills in unit care (item 12). when asked whether their RRT participation increased their workload, 75.4% disagreed or strongly disagreed (item 4).
Few respondents (3.7 %) agreed or strongly agreed that they had been criticized by coworkers because of RRT participation (item 9). In contrast, 82.4% and 86.0% of respondents agreed or strongly agreed that the RRT team communicated effectively (item 3) and responded to calls within an appropriate timeframe, respectively (item 2). When asked whether ward doctors or nurses were supportive of the activation of RRT, 71.2% agreed or strongly agreed with this statement (item 10).
Obstacles to RRT Activation by Residents and Nurses
Table 2 provides descriptive statistics for the 12 questions regarding RRT activation (Figure 3). Exploratory factor analysis was conducted to identify obstacles to RRT activation (Table 3). Only 21.4% and 22.2% of respondents were confident about their knowledge and understanding of activation criteria (agreed or strongly agreed with Items 11 and 12, respectively). However, because 40.6% and 25% of respondents explicitly indicated that they did not know the criteria (disagreed or strongly disagreed with Items 11 and 12, respectively). This was included as Factor 1 and labeled “lack of awareness of activation criteria.”
When asked if they felt confident activating the RRT, 54.4% of respondents agreed or strongly agreed (Item 1), whereas 85.7% agreed or strongly agreed that they would call the doctor in charge before the RRT when one of their patients was unwell (Item 4). In addition, 40.1% agreed or strongly agreed that they would call the RRT if they could not contact the doctor in charge about a sick patient (Item 5). This was included as factor 2 and was labeled “traditional hierarchy reporting.”
Only 16.3% of respondents agreed or strongly agreed that they were reluctant to activate an RRT call due to fear of being criticized for an insufficient reason (item 8). However, among the respondents, 66.7% agreed or strongly agreed when asked if they consult other doctors or nurses before calling an RRT (item 6), and 71.5% agreed or strongly agreed when asked if they activate an RRT when a sick patient deteriorates despite management efforts (item 7). Both items relate to management of sick patients before activating the RRT, likely due to concerns about maintaining a professional reputation and avoiding negative perceptions, which is particularly relevant in Asian societies. This was named Factor 3 and was labeled “social sensitivity.” These three factors explained 55.97% of the total variance in the barriers to activation of RRT.
In the subgroup analysis by professional group (nurses and residents), factor 1 was consistent across the groups, while factors 2 and 3 showed minor variations in specific survey items but maintained largely similar patterns overall (Supplementary Tables 4 and 5). Among the nursing staff, regardless of their experience or assigned ward, the trends in responses to items 11 and 12, which correspond to Factor 1, were similar to those of the overall results. Specifically, the proportions of respondents selecting “strongly disagree” or “disagree” were 20%–30% and 5%–10%, respectively, aligning closely with the overall findings. Because all nursing staff respondents had less than 5 years of experience, the effect of variability in career length or work location was negligible.
In this study, we used a modified personal interview with a 24-item Likert agreement scale questionnaire to assess nurse and resident attitudes toward RRT in a tertiary care hospital. Specifically, we aimed to describe the levels of satisfaction with RRT and determine the key variables that interfere with RRT activation. Most of the nurses and residents surveyed reported that an RRT improves patient safety, clinical skills, and knowledge of patient management. In the open-ended comments, many respondents suggested converting to a full-time RRT, indicating a high degree of satisfaction with its use. Although most respondents reported positive experiences with activating an RRT, their action may be affected by traditional social and cultural barriers, including fear of negative perceptions and hierarchy in patient care.
Consistent with our results, previously published studies have demonstrated that nurses greatly value the ability of RRTs to improve patient care and the nursing environment. In a cross-sectional questionnaire survey of 275 practice nurses from a large academic hospital in Canada, 84.2% of respondents reported that an RRT can prevent cardiopulmonary arrest in acutely ill patients, and 81.3% stated that the RRT did not increase their workload [13]. Jones et al. [11] administered a questionnaire to ward nursing staff at Austin Hospital in Texas, United States. They reported that 91% and 97% of respondents felt that the RRT prevented cardiac arrests and helped manage sick ward patients, respectively.
According to previous studies, RRTs may decrease in-hospital cardiac arrest and mortality [4]. A post hoc analysis of a multicenter randomized controlled trial of RRTs showed significant reduction in cardiac arrest and mortality. The same study found a significant and linear decrease in poor outcomes as RRT responses increased. At our institution, implementing a part-time RRT was followed by a reduction in the incidence of cardiopulmonary arrest outside the ICU only during RRT operating times [7,14]. The RRT was associated with a decrease in-hospital cardiac arrest rates, reduced mortality due to sepsis, and improved first-attempt intubation success rate. These favorable outcomes may have contributed to respondents’ positive attitudes toward RRTs in previous studies.
In the present study, 40.6% and 25% of respondents (disagreed or strongly disagreed with items 11 and 12 in Table 2, respectively) indicated that they did not know the criteria for activating an RRT. Lack of awareness of activation criteria was an important barrier to RRT activation [4]. Furthermore, although most nurses and residents reported appreciating the potential benefits and felt confident when activating the RRT, activation was hindered by traditional, social, and cultural barriers. The majority of respondents would first call the supervising or senior doctor before activating the RRT, reflecting the traditional Asian hierarchical dynamics of the medical community [13,15,16]. This is supported by Braaten [17], who described an established hierarchical culture in hospitals in Colorado, United States. Most nurses reportedly prefer to assess a situation first with other nurses, then the nurse in charge, and finally physicians before activating an RRT. The barriers to RRT activation arising from low nurse and resident awareness and lack of confidence in the criteria can be effectively mitigated through ongoing education on RRT protocols. According to other studies, regular and ongoing training, task bundling, fostering deep mutual and professional trust, and applying new machine learning algorithms could improve RRT activation rates [18-21].
Another barrier to RRT activation is the fear of embarrassment or shame if other doctors or nurses, rather than the RRT team itself, interprets the activation call as evidence of failure to adequately manage the patient. This was labeled “social sensitivity” and is characteristic of East Asian societies, particularly in China, Korea, and Japan, where it is closely tied to the concept of shame [22,23]. Shame arises when physicians or nurses feel that they have failed to fulfill their primary responsibilities in managing patients. As a result, many respondents in our study preferred to first discuss the patient’s condition with colleagues or attempt to manage the situation themselves before calling the RRT. This behavior stems from a desire to preserve one’s professional and personal reputation. Consequently, the rate of direct RRT activation was lower than it might have otherwise been, and many respondents reported a lack of knowledge and understanding of the RRT activation criteria. This factor has not been identified in studies on barriers to RRT initiation in Western countries [24], where RRT members who challenged the justification for activation or were perceived as intimidating, overly demanding, or patronizing usually deterred future activation [25]. Efforts are being made to strengthen the screening system, encourage RRT initiation through repetitive training, and address this barrier by introducing and rewarding successful RRT cases. In response to these challenges, the low direct-activation rate of the Korean RRS has been addressed by implementing EMR screening methods and proactive rounds [7,26]. EMR screening includes single-parameter and multiparameter early warning systems (EWSs). In this present study, a single-parameter EWS was used as such systems can identify extreme deterioration in a single parameter [27]. In addition to these objective criteria-based RRT activation methods, staff can also initiate its activation. A previous study reported that the number of nurse-initiated RRT activations was higher after implementation of the Modified Early Warning System (MEWS) compared with before its use (39 vs. 55 activations) [28]. A prospective study conducted in Korea showed that Deep learning–based Cardiac Arrest Risk Management System (DeepCARS), which is a deep-learning-based EWS, more accurately and efficiently predicted in-hospital cardiac arrests and unplanned ICU transfers compared with traditional multi-parameter EWSs, such as MEWS and the National Early Warning Score [29]. These findings suggest that such deep-learning methods can help address low rates of RRT activation.
Our study had several limitations. First, a response bias may have affected the results as residents or nurses who were dissatisfied with the RRT may not have participated in the survey. Replies from non-responders would help us better understand the barriers to RRT activation. Second, our survey represented the opinions of residents and nurses at a single center in Asia, and its results cannot be generalized to other hospitals in different regions. However, studies regarding the RRS experiences of nurses and residents in Asia are limited, and barriers to the activation of RRS have not been properly evaluated. To the best of our knowledge, this is the first report on clinical experiences with an RRS in a country outside North America, Europe, or Australia. Third, our study was conducted during the early implementation phase of an RRS, capturing critical baseline data on activation barriers and perceptions among nurses and residents. Future studies should examine how these challenges and perspectives change over time. Finally, items in the questionnaire might have been correlated for unexplained reasons in principal component analysis, which may lead to misinterpretation of potential barriers to RRT activation.
In conclusion, nurses and residents value RRTs and recognize the potential benefits in patient care. However, successful activation of RRTs faces significant barriers, primarily a lack of confidence in applying the criteria. The traditional hierarchical approach in Korea and cultural concerns such as fear of criticism can further deter RRT activation. Addressing these challenges through education and using clear protocols can enhance RRT activation and use.
▪ Nurses and residents value rapid response team (RRT) services and appreciate their potential benefits.
▪ The major barriers to calling an RRT appear to be a lack of awareness of activation criteria and a sense of honor and allegiance to traditional approaches in Korean culture.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

Conceptualization: all authors. Methodology: all authors. Software: SYL, HGW, YJL. Validation: all authors. Formal analysis: SYL, HGW, YJL. Investigation: SYL, HGW, YJL. Resources: all authors. Data curation: all authors. Visualization: SYL, HGW, YJL. Supervision: all authors. Project administration: all authors. Funding acquisition: YJL. Writing - original draft: all authors. Writing - review & editing: all authors. All authors read and agreed to the published version of the manuscript.

Supplementary materials can be found via https://doi.org/10.4266/acc.004272.
Supplementary Table 1.
Criteria for activating RRT at Seoul National University Bundang Hospital
acc-004272-Supplementary-Table-1.pdf
Supplementary Table 2.
Summary of open-ended survey responses on RRT (nurses)
acc-004272-Supplementary-Table-2.pdf
Supplementary Table 3.
Summary of open-ended survey responses on RRT (doctors)
acc-004272-Supplementary-Table-3.pdf
Supplementary Table 4.
Factor analysis of barriers to RRT activation (nurse)
acc-004272-Supplementary-Table-4.pdf
Supplementary Table 5.
Factor analysis of barriers to RRT activation (doctor)
acc-004272-Supplementary-Table-5.pdf
Figure 1.
Flowchart of patient selection and exclusion criteria. After 17 participants were excluded, 358 questionnaires were received, a response rate of 95.47%. Ward nurses and residents submitted 305 and 53 questionnaires, respectively.
acc-004272f1.jpg
Figure 2.
Summary of the aggregate responses to the survey on satisfaction with rapid response team (RRT). A forest plot of the mean responses for each survey item on a 5-point Likert scale, with values ranging from 1 (“strongly agree”) to 5 (“strongly disagree”). Error bars indicate the variability in responses for each item.
acc-004272f2.jpg
Figure 3.
Summary of the aggregate responses to the survey on barriers to rapid response team (RRT) activation. A forest plot of the mean responses for each survey item on a 5-point Likert scale, with values ranging from 1 (“strongly agree”) to 5 (“strongly disagree”). Error bars indicate the variability of responses for each item.
acc-004272f3.jpg
Table 1.
Summary of the aggregate responses to the survey regarding satisfaction of RRT
Survey item Strongly agree Agree Uncertain Disagree Strongly disagree
1. The RRT prevents unwell patients from having cardiac and respiratory arrests. 42.7 50.3 6.4 0.6 0
2. The RRT responds to calls in an appropriate timeframe. 34.6 51.4 13.7 0.3 0
3. The RRT communicates effectively. 31.1 51.3 14.6 2.8 0.3
4. Using the RRT system increases my workload when caring for a sick patient. 2.8 5.0 16.8 44.7 30.7
5. RRT calls teach me how to better manage sick patients in my ward. 22.9 54.2 20.7 2.2 0
6. The RRT is helpful in managing sick patients on the unit. 25.7 56.4 17.0 0.8 0
7. The RRT can be used to prevent a minor problem from becoming a major problem. 29.1 55.3 15.4 0.3 0
8. The RRT allows me to seek help for my patients when I am worried about them. 42.7 51.1 5.6 0.6 0
9. I have been criticized for RRT activation from the team. 0.9 2.8 9.0 45.7 41.5
10. Ward/unit nurses/doctors support my decision to activate RRT. 18.5 52.7 26.3 2.0 0.6
11. I think that the RRT is overused in the management of hospital patients. 2.8 8.1 11.2 51.4 26.5
12. RRT calls improve my skills in managing sick patients. 22.1 50.1 25.5 2.2 0

Numbers within columns indicate the percentage of overall responses for each option in the Likert agreement scale.

RRT: rapid response team.

Table 2.
Summary of the aggregate responses to the survey regarding barrier in activation of RRT
Survey item Strongly agree Agree Uncertain Disagree Strongly disagree
1. I feel confident activating the RRT. 11.5 42.9 29.9 13.6 2.1
2. I would make an RRT call on a patient I am worried about deterioration. 13.1 45.9 26.9 12.8 1.3
3. Even if I am concerned about my sick patient, I do not activate RRT as the patient will be screened by the RRT. 3.2 20.3 27.5 39.7 9.3
4. When one of my patients is sick, I call the covering doctor/senior doctor before calling an RRT. 37.3 48.4 9.9 3.7 0.6
5. I activate an RRT call, if I cannot contact the covering doctor about my sick patient. 9.0 31.1 32.6 22.4 5.0
6. I discuss with other doctors or nurses before calling an RRT. 14.4 52.3 20.3 10.7 2.4
7. I activate an RRT call, if sick patients deteriorate despite the management. 17.6 53.9 21.6 5.9 1.1
8. I am reluctant to activate an RRT call on my patients, because I will be criticized if they are not that unwell. 4.0 12.3 20.3 40.0 23.5
9. I would make an RRT call on a patient I am worried about even if their vital signs are normal. 2.1 13.9 29.1 44.0 10.9
10. If my patient fulfills listed RRT criteria but does not look unwell, I will not activate an RRT call. 1.1 22.1 33.6 33.6 9.6
11. I am aware of RRT calling criteria. 3.5 17.9 38.1 30.7 9.9
12. It is easy to understand RRT calling criteria. 3.5 18.7 52.8 21.3 3.7

Numbers within columns indicate the percentage of overall responses for each option in the Likert agreement scale.

RRT: rapid response team.

Table 3.
Factor analysis for RRT activation
Factor 1 Factor 2 Factor 3 Cronbach α
11. I am aware of RRT calling criteria. 1.023 0.908
12. It is easy to understand RRT calling criteria. 0.835
1. I feel confident activating the RRT. 0.706 0.689
2. I would make an RRT call on a patient I am worried about deterioration. 0.614
5. I activate an RRT call if I cannot contact the covering doctor about my sick patient. 0.485
4. When one of my patients is sick, I call the covering doctor/senior doctor before calling an RRT. 0.752
6. I discuss with other doctors or nurses before calling an RRT. 0.581 0.469
7. I activate an RRT call, if sick patients deteriorate despite the management. 0.511
10. If my patient fulfills listed RRT criteria but does not look unwell, I will not activate an RRT call. 0.475
8. I am reluctant to activate an RRT call on my patients because I will be criticized if they are not that unwell. 0.302
Eigenvalue 2.195 1.508 0.722

These three factors explained 55.97% of the total variance of the barriers to activation of RRT.

RRT: rapid response team,

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        Resident and nurse attitudes toward a rapid response team in a tertiary hospital in South Korea
        Acute Crit Care. 2025;40(1):29-37.   Published online February 12, 2025
        DOI: https://doi.org/10.4266/acc.004272
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      Resident and nurse attitudes toward a rapid response team in a tertiary hospital in South Korea
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      Figure 1. Flowchart of patient selection and exclusion criteria. After 17 participants were excluded, 358 questionnaires were received, a response rate of 95.47%. Ward nurses and residents submitted 305 and 53 questionnaires, respectively.
      Figure 2. Summary of the aggregate responses to the survey on satisfaction with rapid response team (RRT). A forest plot of the mean responses for each survey item on a 5-point Likert scale, with values ranging from 1 (“strongly agree”) to 5 (“strongly disagree”). Error bars indicate the variability in responses for each item.
      Figure 3. Summary of the aggregate responses to the survey on barriers to rapid response team (RRT) activation. A forest plot of the mean responses for each survey item on a 5-point Likert scale, with values ranging from 1 (“strongly agree”) to 5 (“strongly disagree”). Error bars indicate the variability of responses for each item.

      Figure 1.

      Figure 2.

      Figure 3.

      Resident and nurse attitudes toward a rapid response team in a tertiary hospital in South Korea
      Survey item Strongly agree Agree Uncertain Disagree Strongly disagree
      1. The RRT prevents unwell patients from having cardiac and respiratory arrests. 42.7 50.3 6.4 0.6 0
      2. The RRT responds to calls in an appropriate timeframe. 34.6 51.4 13.7 0.3 0
      3. The RRT communicates effectively. 31.1 51.3 14.6 2.8 0.3
      4. Using the RRT system increases my workload when caring for a sick patient. 2.8 5.0 16.8 44.7 30.7
      5. RRT calls teach me how to better manage sick patients in my ward. 22.9 54.2 20.7 2.2 0
      6. The RRT is helpful in managing sick patients on the unit. 25.7 56.4 17.0 0.8 0
      7. The RRT can be used to prevent a minor problem from becoming a major problem. 29.1 55.3 15.4 0.3 0
      8. The RRT allows me to seek help for my patients when I am worried about them. 42.7 51.1 5.6 0.6 0
      9. I have been criticized for RRT activation from the team. 0.9 2.8 9.0 45.7 41.5
      10. Ward/unit nurses/doctors support my decision to activate RRT. 18.5 52.7 26.3 2.0 0.6
      11. I think that the RRT is overused in the management of hospital patients. 2.8 8.1 11.2 51.4 26.5
      12. RRT calls improve my skills in managing sick patients. 22.1 50.1 25.5 2.2 0
      Survey item Strongly agree Agree Uncertain Disagree Strongly disagree
      1. I feel confident activating the RRT. 11.5 42.9 29.9 13.6 2.1
      2. I would make an RRT call on a patient I am worried about deterioration. 13.1 45.9 26.9 12.8 1.3
      3. Even if I am concerned about my sick patient, I do not activate RRT as the patient will be screened by the RRT. 3.2 20.3 27.5 39.7 9.3
      4. When one of my patients is sick, I call the covering doctor/senior doctor before calling an RRT. 37.3 48.4 9.9 3.7 0.6
      5. I activate an RRT call, if I cannot contact the covering doctor about my sick patient. 9.0 31.1 32.6 22.4 5.0
      6. I discuss with other doctors or nurses before calling an RRT. 14.4 52.3 20.3 10.7 2.4
      7. I activate an RRT call, if sick patients deteriorate despite the management. 17.6 53.9 21.6 5.9 1.1
      8. I am reluctant to activate an RRT call on my patients, because I will be criticized if they are not that unwell. 4.0 12.3 20.3 40.0 23.5
      9. I would make an RRT call on a patient I am worried about even if their vital signs are normal. 2.1 13.9 29.1 44.0 10.9
      10. If my patient fulfills listed RRT criteria but does not look unwell, I will not activate an RRT call. 1.1 22.1 33.6 33.6 9.6
      11. I am aware of RRT calling criteria. 3.5 17.9 38.1 30.7 9.9
      12. It is easy to understand RRT calling criteria. 3.5 18.7 52.8 21.3 3.7
      Factor 1 Factor 2 Factor 3 Cronbach α
      11. I am aware of RRT calling criteria. 1.023 0.908
      12. It is easy to understand RRT calling criteria. 0.835
      1. I feel confident activating the RRT. 0.706 0.689
      2. I would make an RRT call on a patient I am worried about deterioration. 0.614
      5. I activate an RRT call if I cannot contact the covering doctor about my sick patient. 0.485
      4. When one of my patients is sick, I call the covering doctor/senior doctor before calling an RRT. 0.752
      6. I discuss with other doctors or nurses before calling an RRT. 0.581 0.469
      7. I activate an RRT call, if sick patients deteriorate despite the management. 0.511
      10. If my patient fulfills listed RRT criteria but does not look unwell, I will not activate an RRT call. 0.475
      8. I am reluctant to activate an RRT call on my patients because I will be criticized if they are not that unwell. 0.302
      Eigenvalue 2.195 1.508 0.722
      Table 1. Summary of the aggregate responses to the survey regarding satisfaction of RRT

      Numbers within columns indicate the percentage of overall responses for each option in the Likert agreement scale.

      RRT: rapid response team.

      Table 2. Summary of the aggregate responses to the survey regarding barrier in activation of RRT

      Numbers within columns indicate the percentage of overall responses for each option in the Likert agreement scale.

      RRT: rapid response team.

      Table 3. Factor analysis for RRT activation

      These three factors explained 55.97% of the total variance of the barriers to activation of RRT.

      RRT: rapid response team,

      Table 1.

      Table 2.

      Table 3.

      ACC : Acute and Critical Care
      © The Korean Society of Critical Care Medicine.
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