C56-32 Structural and Process Variability in Rapid Response Teams: An Exploratory Survey Across the Top Performing U.S. Hospitals

Rationale Rapid Response (RR) systems identify, treat, and triage hospitalized patients deteriorating outside the intensive care unit. Despite improvement efforts, standardized structures and quality metrics remain undefined. To address this gap, we surveyed RR systems in top-performing U.S. hospitals. Methods Survey design and analysis was informed by Donabedian’s framework and the McKinsey 7-S model. One hundred hospitals were selected from the U.S. News & World Report Top 25 (2020-2025) and Vizient’s high-performing institutions. The survey evaluated RR team structure, processes, resources, and quality improvement (QI) activities. Data was collected from March to September 2025. Univariable analyses used Fisher’s exact test, t-test, and Wilcoxon rank-sum test, with Cramer’s V assessing association strength. Results A total of 36 participants were included in the analysis. Majority were affiliated with academic medical centers (30, 83.3%), while five participants represented community hospitals (13.9%). Rapid Response Volume Fifteen participants (41.7%) reported an average number of RR activations during a 12-hour shift 0-5, whereas 12 participants (33.3%) reported 5-10 activations. Seven participants (19.3%) reported high volume (>10) activations per 12-hour shift. Team Characteristics The majority of participants (28; 77.8%) reported having a single RR team within their institution. respondents (32; 89%) indicated the presence of a critical care nurse, and 26 (72%) reported inclusion of a provider, while 10 (27.8%) did not. Provider roles varied substantially. More than half (19; 52.8%) reported that their RR team was physician-led. Dedicated Resources Sixteen participants (44%) reported access to dedicated resources, such as ultrasound or arterial blood gas machines.Geographic Layout More than half of the participants (20; 55.6%) reported that their RR team covers multiple towers. Eight participants (22.2%) indicated that they have at least one ‘distant’ location. Associations Preliminary analyses suggested the presence of associations among the following pairs: (1) Variations in RR volume and team components; (2) Differences associated with hospital type and RR team composition; (3) Bed capacity and the geographic distribution of RR teams. Quality Improvement The majority (81%) reported RR team involvement in QI activities. Several QI components were evident, including iterative structural modifications in response to patient needs. However, substantial variability was observed in quality review methods, metrics, and oversight processes. Conclusions RR structure and resources are not standardized, even at top performing hospitals. Simiarly, there is noted variability in quality oversight. Further research will focus on the strength of structural associations and creating models for quality best practices related to RR. This abstract is funded by: Eleanor Wood Prince Grant Initiative