Executive Summary: Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU

RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS). The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww. com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients. The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww. com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document.We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.RATIONALE:Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among "unselected" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.Early identification and prompt response to clinical deterioration confer the greatest chance of improving outcomes among patients hospitalized outside the ICU. Healthcare institutions employ various means to better detect and treat critical illness in these patients, ranging from the use of vital sign-based guidelines, electronic surveillance, and deployment of ICU-based outreach teams for obtaining help. We provide evidence-based recommendations to guide clinicians and institutional leaders in implementing systems intended to improve patient safety and reduce morbidity and mortality. This guideline is intended to be a new Society of Critical Care Medicine guideline. We provide a detailed description of the methodology in the main guideline document. We issued 10 clinical practice guideline statements: four Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendations, three "no recommendations," and three good practice statements (GPSs) on recognizing and responding to clinical deterioration outside the ICU. The accompanying full article (1) describes practice guideline statements with the rationale for each. Please refer to the supplemental digital content for the scope of the guideline and PICO questions (Supplemental Digital Content 3, http://links.lww.com/CCM/H433), outcome prioritization (Supplemental Digital Content 4, http://links.lww.com/CCM/H433), literature search strategy (Supplemental Digital Content 5, http://links.lww.com/CCM/H433), systematic review process and data synthesis (Supplemental Digital Content 6, http://links.lww.com/CCM/H433), GRADE methodology (Supplemental Digital Content 7, http://links.lww.com/CCM/H433), details on Good Practice Statements (Supplemental Digital Content 8, http://links.lww.com/CCM/H433), final voting process and results (Supplemental Digital Content 9, http://links.lww.com/CCM/H433), and evidence profiles and forest plots pertaining to each recommendation (Supplemental Digital Content 10, http://links.lww.com/CCM/H433). The infographic (Fig. 1) presents an abbreviated summary containing the seven actionable recommendations.Society of Critical Care Medicine (SCCM) guidelines on recognizing and responding to critical illness outside the ICU 2023: Key recommendations. MD = medical doctor, MET = medical emergency team, RN = registered nurse, PICO = Population, Intervention, Control, and Outcomes, RT = respiratory therapist, RRT = rapid response team.