Recognizing and Responding to Clinical Deterioration Outside the ICU

Publication Date: January 19, 2024
Last Updated: January 24, 2024

Summary of Recommendations

Recognizing Clinical Deterioration

Ward staff caring for hospitalized patients should strive to acquire a complete and accurate set of vital signs when ordered and when there is additional cause for concern, and to escalate the reporting of significant abnormalities to the appropriate clinicians in an urgent manner. (U, CC)
We make no recommendation regarding the routine use of continuous vital sign monitoring to recognize early clinical deterioration in unselected non-ICU patients. (U, U)
We suggest focused education of direct-care non-ICU hospital clinicians on recognizing early clinical deterioration. (C, L )
Patients, families, and care partners of hospitalized patients are able to recognize subtle differences in clinical status that may signify deterioration and should be empowered to alert appropriate personnel including the rapid response system. (U, CC)
We suggest that patient, family, and care partner concerns be incorporated into hospital early warning systems. (C, L )

Responding to Clinical Deterioration

We recommend hospital-wide deployment of rapid response systems (i.e., RRT/MET) for non-ICU patients that include explicit activation criteria for obtaining help from a designated response team. (S, M )
We make no recommendations regarding 1) whether an RRT/MET should be led by a prescribing clinician vs. a non-prescribing clinician; and 2) whether an RRT/MET should be led by a physician as compared to other healthcare providers. (U, U)
We make no recommendation about involvement of palliative care-trained personnel as part of an RRT/MET. (U, U)
We suggest ensuring that responding clinicians have expertise on eliciting patients’ goals of care and establishing treatment plans that best reflect their wishes and prognoses. (C, L )
A process for quality improvement should be part of a Rapid Response System. (U, CC)

Recommendation Grading


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Recognizing and Responding to Clinical Deterioration Outside the ICU

Authoring Organization

Publication Month/Year

January 19, 2024

Last Updated Month/Year

February 1, 2024

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.

Target Patient Population

All hospitalized non-ICU patients

Target Provider Population

All clinicians caring for hospitalized patients

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings


Intended Users

Nurse, nurse practitioner, physician, physician assistant


Treatment, Management, Prevention

Diseases/Conditions (MeSH)

D000075902 - Clinical Deterioration


clinical deterioration

Source Citation

Honarmand, Kimia MD, MSc1,2; Wax, Randy S. MD, MEd, FRCPC, FCCM3,4; Penoyer, Daleen PhD, RN, CCRP, FCNS, FCCM5; Lighthall, Geoffery MD, PhD6,7; Danesh, Valerie PhD, RN, FCCM8; Rochwerg, Bram MD, MSc1,2,9; Cheatham, Michael L. MD, FCCM10; Davis, Daniel P. MD11; DeVita, Michael MD, FRCP, FCCM12; Downar, James MDCM, MHSc, FRCPC13; Edelson, Dana MD, MS14; Fox-Robichaud, Alison MSc, MD, FRCPC15; Fujitani, Shigeki MD, PhD, FCCM16; Fuller, Raeann M. MSN, RN, CCRN-K17; Haskell, Helen18; Inada-Kim, Matthew MD19; Jones, Daryl MD, PhD20; Kumar, Anand MD, FCCM21; Olsen, Keith M. PharmD, FCCM22; Rowley, Daniel D. MSc, RRT-ACCS23; Welch, John RN, BSc, MSc24; Baldisseri, Marie R. MD, MPH, FCCM25; Kellett, John MD26; Knowles, Heidi MD27; Shipley, Jonathan K. AGACNP-DNP28; Kolb, Philipp29,30; Wax, Sophie P.31; Hecht, Jonathan D. MSN, APRN, CCRN32; Sebat, Frank MS, MD, FCCM33. Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023. Critical Care Medicine 52(2):p 314-330, February 2024. | DOI: 10.1097/CCM.0000000000006072

Supplemental Methodology Resources

Data Supplement