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start of RRT with 24,978 patients hospitalized after the RRT was put in place. RRT was activated 376 times in a period of 20 months. Findings: Decrease in cardiac arrests from 11.2 to 7.5 cardiac arrests per 1,000 patients Benefits of RRT • Improved patient safety and shorter hospital stays • Fewer code blues and fewer transfers to ICU • Increased awareness by nurses of signs and symptoms leading to deterioration in a patient’s condition • Decline in hospital mortality and morbidity • Avoidance of pain and suffering • Increased satisfaction of patients • Increased job satisfaction among nurses RRTs…They do save lives! Dr. Don Berwick, President and CEO of IHI, stated: “The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them.” Needed Action Hospitals in Lebanon are encouraged to consider the implementation of RRTs as an evidence-based approach to improve the efficiency of early intervention and reduce the risk of delayed attendance to cardio-pulmonary arrests. Rapid-Response Teams Daryl A. Jones, M.D., M.B., B.S., Michael A. DeVita, M.D., and Rinaldo Bellomo, M.D., M.B., B.S. From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC (D.A.J.); and the Department of Intensive Care, Austin Hospital, Heidelberg, VIC (D.A.J., R.B.) — both in Australia; and the Departments of Critical Care Medicine and Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh (M.A.D.). Address reprint requests to Dr. Bellomo at the Intensive Care Unit, Austin Hospital, Studley Rd., Heidelberg, VIC, 3084 Australia, or at rinaldo.bellomo@austin.org.au. N Engl J Med 2011;365:139-46. Copyright © 2011 Massachusetts Medical Society. Rapid-response teams have been introduced to intervene in the care of patients with unexpected clinical deterioration. These teams are key components of rapid-response systems, which have been put in place because of evidence of “failure to rescue” with available clinical services, leading to serious adverse events.1 A serious adverse event may be defined as an unintended injury that is due in part to delayed or incorrect medical management and that exposes the patient to an increased risk of death and results in measurable disability.2 Rapidresponse systems aim to improve the safety of hospital-ward patients whose condition is deteriorating. These systems are based on identification of patients at risk, early notification of an identified set of responders, rapid intervention by the response team, and ongoing evaluation of the system’s performance and hospital-wide processes of care.1 Rapid-response systems have been implemented in many countries and across the United States.3,4 Rapid-response teams differ from traditional code teams in a number of ways (Table 1). They assess a greater number of hospitalized patients at an earlier stage of clinical deterioration, with the aim of preventing serious adverse events such as cardiac arrests and unexpected deaths. Thus, rapid-response teams assess patients in whom respiratory, neurologic, or cardiac deterioration develops rather than patients who have already had a respiratory or cardiac arrest.5 Whether rapid-response systems are effective is controversial. Their introduction was prompted by five before-and-after comparisons that were single-center studies.6-11 These studies showed a reduction in the rate of cardiac arrests and a greater effect with a greater “dose” of care from the rapid-response team (i.e., a larger number of assessments per 1000 admissions).12 However, a major multicenter, cluster-randomized, controlled trial called the Medical Early Response Intervention and Therapy (MERIT) study failed to demonstrate a benefit. Moreover, the results of meta-analyses have questioned whether there are benefits and have suggested that further research is required.13,14 This article explores the prevalence and consequences of sudden critical illness outside the intensive care unit (ICU) and reviews the concept of a rapid-response system and the controversies surrounding the increasing use of such systems. Fa ilure t o Rescue In patients