Table 3.

Synthesized findings in accordance with the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations Framework.

Pattern	Advances	Gaps	Evidence for practice	Research recommendations
Triggers Used to Activate Medical Emergency Team Events	Importance of including triggers in reporting seems to be widely recognized as most studies at least identified triggers used. Wide variability in the frequencies of types of triggers used were reported. Use of respiratory triggers and multiple triggers to activate medical emergency team events were common and seemed to be associated with adverse patient outcomes.	Few statistical analyses were performed to examine relationships between triggers and outcomes related to rapid response systems. Wide variability in how studies reported triggers creates difficulty in comparing findings. Additional details regarding the patterns in which multiple triggers occurred was lacking.	Variability in reporting trigger data and the lack of associative analyses to elucidate which triggers or groups of triggers are associated with adverse outcomes limits the clinical usefulness of findings related to trigger use.	Future research needs to move beyond descriptive statistics and analyze relationships between triggers and rapid response system outcomes more directly. The patterns in which multiple triggers are used to activate medical emergency team events should be identified and their relationships with patient outcomes studied. Scholarly journals need to enforce uniformity in the reporting data on rapid response systems, and reporting guidelines should be expanded to include more details related to rapid response system components.
Medical Emergency Team Member Composition	Most studies reported at least some information on team composition, indicating recognition of the importance of this component. Teams with at least one dedicated member seem to be associated with significant decreases in-hospital cardiac arrests.	Wide variability in how studies reported member composition creates difficulty in comparing findings.	Dedicated members of medical emergency teams should be considered to reduce incidence of in-hospital cardiac arrests.	Scholarly journals need to enforce uniformity in the reporting data on rapid response systems, and reporting guidelines should be expanded to include more details related medical emergency team member composition within rapid response systems.
Additional Roles of Rapid Response System Outside of Medical Emergency Team Events	When additional roles were described, educator roles related to helping clinicians better recognize clinical deterioration and use of the rapid response system were common. Proactive rounding was also common when additional roles were described.	Rapid response systems that described education efforts and proactive rounding as additional roles were commonly associated with either significantly decreased incidences of in-hospital cardiac arrest or hospital mortality. Almost all did not directly assess these roles as they related to relevant outcomes.	Additional rapid response system roles in clinician education and proactive rounding should be considered to reduce incidence of in-hospital cardiac arrests and hospital mortality.	Future research should further explore and directly assess how roles involving clinician education and proactive rounding within rapid response systems are related to the reduction of in-hospital cardiac arrests and hospital mortality.
Rapid Response System Involvement in Goals of Care Discussions and “Do-Not-Resuscitate” Order Placements	Studies that described rapid response system involvement in goals of care discussions and the placement of Do-Not-Resuscitate orders largely did not report data on this component. Conversely, the studies that did report this data did not describe to what extent rapid response systems were formally involved in these discussions. Patients with increased “passages of time” were more likely to have goals of care discussions related to medical emergency team events.	Almost none of the studies that described formal involvement of rapid response systems in goals of care discissions or Do-Not-Resuscitate order placement tested their relationships to relevant patient outcomes. Conversely, the studies that did assess those relationships did not describe how rapid response systems were intended to be involved. These inconsistencies make comparisons across studies difficult.	Findings related to increased “passage of time” being associated with more goals of care discussions represents a gap in adequate quality patient care, and should encourage clinicians to have these conversations with patients well before episodes of acute deterioration.	Clear descriptions of rapid response system involvement in these aspects of patient care are needed, along with more direct assessments of the their relationships with other components and outcomes related to rapid response systems. Scholarly journals need to enforce uniformity in the reporting data on rapid response systems, and reporting guidelines should be expanded to include more details related to rapid response system components.