Rapid Response Systems
COVID-19 (Critical Care)

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Society of Intensive Care Medicine (Singapore)
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Rapid Response Systems

List of Research Publications on Rapid Response System in Singapore

Liaw, S. Y., Wong, L. F., Ang, S. B., Ho, J. T., Siau, C., & Ang, E. N. (2016).
Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.
BMJ quality & safety, 25(6), 448–456.
Chua, W. L., See, M. T. A., Legio-Quigley, H., Jones, D., Tee, A., & Liaw, S. Y. (2017).
Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review.
International journal for quality in health care, 29(8), 981–998.
Lim, W. T., Fang, A. H., Loo, C. M., Wong, K. S., & Balakrishnan, T. (2019).
Use of the National Early Warning Score (NEWS) to Identify Acutely Deteriorating Patients with Sepsis in Acute Medical Ward.
Annals of the Academy of Medicine, Singapore, 48(5), 145–149.
Liaw, S. Y., Tee, A., Carpio, G. A. C., Ang, S. B. L., & Chua, W. L. (2020).
Review of systems for recognising and responding to clinical deterioration in Singapore hospitals: a nationwide cross-sectional study.
Singapore medical journal, 61(4), 184–189.
Chua, W. L., Legido-Quigley, H., Jones, D., Hassan, N. B., Tee, A., & Liaw, S. Y. (2020).
A call for better doctor-nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients.
Australian critical care, 33(1), 54–61.
Tan, C. L., Goh, C., & Tan, T. K. (2020).
Implementation of the rapid response system in the acute care ecosystem.
Singapore medical journal, 61(11), 563–565.
Fang, A. H. S., Lim, W. T., & Balakrishnan, T. (2020).
Early warning score validation methodologies and performance metrics: a systematic review.
BMC medical informatics and decision making, 20(1), 111.
Chua, W. L., Tee, A., Hassan, N. B., Jones, D., Tam, W. W. S., & Liaw, S. Y. (2021).
The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale.
Australian critical care, 34(4), 340–349.
Goh, K. J., Chai, H. Z., Ng, L. S., Phone Ko, J., Tan, D. C. X., Tan, H. L., Teo, C. W. S., Phua, G. C., & Tan, Q. L. (2021).
Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study.
Annals of the Academy of Medicine, Singapore, 50(11), 838–847.
Chua, W. L., Smith, D., Wee, L. C., Ting, K. C., Yeo, M. L. K., Mordiffi, S. Z., & Liaw, S. Y. (2023).
Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale.
Journal of clinical nursing, 32(11-12), 2684–2699.
Chua, W. L., Wee, L. C., Lim, J. Y. G., Yeo, M. L. K., Jones, D., Tan, C. K., Khan, F. A., & Liaw, S. Y. (2023).
Automated rapid response system activation-Impact on nurses' attitudes and perceptions towards recognising and responding to clinical deterioration: Mixed-methods study.
Journal of clinical nursing, 32(17-18), 6322–6338.
Ko, J. P., Ng, L. S., Goh, K. J., Chai, H. Z., Phua, G. C., & Tan, Q. L. (2023).
Staff perception and attitudes towards a medical rapid response team with a multi-tiered response.
Singapore medical journal, 64(8), 527–533.
Tee, A., Choo, B. P., Gokhale, R. S., Wang, X., Mansor, M., Oh, H. C., & Jones, D. (2023).
Findings from a decade of experience following implementation of a Rapid Response System into an Asian hospital.
Resuscitation plus, 16, 100461.

List of ongoing research activities

  • Early warning scores for sepsis identification and prediction of in-hospital mortality in adults with sepsis: a systematic review and meta-analysis
    Investigators: Dr Chua Wei Ling (NUS Nursing), Prof Leanne Aitken (City, University of London), Khairul Dzakirin Bin Rusli (NUS Nursing)
  • Influence of habit on behaviours underpinning afferent limb of the rapid response system: an international cross-sectional study.
    Countries: United Kingdom, Singapore, Belgium, Finland
    Singapore PI: Dr Chua Wei Ling (NUS Nursing)
  • Cost Analysis of a Rapid Response system in a Singapore tertiary-care hospital.
    Investigators: Augustine Tee, Bryan Choo, Daryl Jones
    Site: Changi General Hospital, Singapore
  • Antecedents to in-hospital cardiac arrest study.
    Investigators: Roshni Gokhale, Augustine Tee
    Site: Changi General Hospital Singapore
  • Early prediction of clinical deterioration in admitted Asian cohort through supervised machine learning model.
    Investigators: Aza Taha, Thanawin Trakoolwilaiwan, Wu Min, Khue, Liu Wei, Marissa Lynn, Sherly, Xu Yu, Gurpreet Singh, Augustine Tee, Malini Olivo


Lau YH et al. Point-of-care ultrasound training among intensivists in Singapore: a multicentre survey.
Ann Acad Med Singapore 2020 Sep;49(9):630-642
Kansal A et al. Predictors and outcomes of high-flow nasal cannula failure following extubation: A multi-centre observational study
Ann Acad Med Singap. 2021 Jun;50(6):467-473. doi: 10.47102/annals-acadmedsg.2020564
Puah SH et al. High flow nasal cannula therapy: a multi-centered survey of the practices among physicians and respiratory therapists in Singapore.
Aust Crit Care. 2021 Sep 10:S1036-7314(21)00127-2. doi: 10.1016/j.aucc.2021.08.001.
Li A et al. Expanding the utility of the rox index among patients with acute hypoxemic respiratory failure.
PLoS One 2021
Click Here for article
National Centre for Infectious Diseases's Research Publications
Click Here for article
Coronavirus Disease 2019 in Critically Ill Children
A Narrative Review of the Literature Click Here for article
Practical advice from the frontline of SARS-CoV-2 outbreak
Click here for article

COVID-19 (Critical Care)

Guidelines and consensus statements

Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations.

Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, Shrestha BR, Arabi YM, Ng J, Gomersall CD, Nishimura M, Koh Y, Du B; Asian Critical Care Clinical Trials Group. Lancet Respir Med. 2020 May;8(5):506-517. doi: 10.1016/S2213-2600(20)30161-2. Epub 2020 Apr 6.PMID: 32272080 Free PMC article. Review.

Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure.

Bartlett RH, Ogino MT, Brodie D, McMullan DM, Lorusso R, MacLaren G, Stead CM, Rycus P, Fraser JF, Belohlavek J, Salazar L, Mehta Y, Raman L, Paden ML. ASAIO J. 2020 May;66(5):472-474. doi: 10.1097/MAT.0000000000001173.PMID: 32243267 No abstract available.


The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status.

Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, Tan KS, Wang DY, Yan Y. Mil Med Res. 2020 Mar 13;7(1):11. doi: 10.1186/s40779-020-00240-0.PMID: 32169119Free PMC article. Review

Epidemiological and Clinical Predictors of COVID-19

Sun Y, Koh V, Marimuthu K, Ng OT, Young B, Vasoo S, Chan M, Lee VJM, De PP, Barkham T, Lin RTP, Cook AR, Leo YS. Clin Infect Dis. 2020 Mar 25:ciaa322. doi: 10.1093/cid/ciaa322. Online ahead of print. PMID: 32211755

Lymphopenia Is Associated With Severe Coronavirus Disease 2019 (COVID-19) Infections: A Systemic Review and Meta-Analysis

Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Deng Y, Weng Z, Yang L. Int J Infect Dis. 2020 May 4;96:131-135. doi: 10.1016/j.ijid.2020.04.086. Online ahead of print. PMID: 32376308 Free PMC article.

Respiratory Sampling for Severe Acute Respiratory Syndrome Coronavirus 2: An Overview

See A, Toh ST. Head Neck. 2020 May 1. doi: 10.1002/hed.26232. Online ahead of print. PMID: 32357381


The Trinity of COVID-19: Immunity, Inflammation and Intervention

Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. Nat Rev Immunol. 2020 Apr 28:1-12. doi: 10.1038/s41577-020-0311-8. Online ahead of print. PMID: 32346093Free PMC article. Review.

Hematologic Parameters in Patients With COVID-19 Infection

Fan BE. Am J Hematol. 2020 Apr 27. doi: 10.1002/ajh.25847. Online ahead of print.PMID: 32339335 No abstract available.

Critically Ill COVID-19 Infected Patients Exhibit Increased Clot Waveform Analysis Parameters Consistent With Hypercoagulability

Tan CW, Low JGH, Wong WH, Chua YY, Goh SL, Ng HJ. Am J Hematol. 2020 Apr 8. doi: 10.1002/ajh.25822. Online ahead of print.PMID: 32267008 No abstract available.


COVID-19 in Singapore-Current Experience: Critical Global Issues That Require Attention and Action

Wong JEL, Leo YS, Tan CC. JAMA. 2020 Feb 20. doi: 10.1001/jama.2020.2467. Online ahead of print. PMID: 32077901No abstract available.

Preparing for COVID-19: Early Experience From an Intensive Care Unit in Singapore

Liew MF, Siow WT, MacLaren G, See KC. Crit Care. 2020 Mar 9;24(1):83. doi: 10.1186/s13054-020-2814-x. PMID: 32151274Free PMC article. No abstract available.

Safe Patient Transport for COVID-19

Liew MF, Siow WT, Yau YW, See KC. Crit Care. 2020 Mar 18;24(1):94. doi: 10.1186/s13054-020-2828-4.PMID: 32183864Free PMC article. No abstract available.

Managing COVID-19 in Resource-Limited Settings: Critical Care Considerations

Siow WT, Liew MF, Shrestha BR, Muchtar F, See KC. Crit Care. 2020 Apr 22;24(1):167. doi: 10.1186/s13054-020-02890-x.PMID: 32321566Free PMC article. No abstract available.

Operational Strategies to Prevent Coronavirus Disease 2019 (COVID-19) Spread in Radiology: Experience From a Singapore Radiology Department After Severe Acute Respiratory Syndrome

Goh Y, Chua W, Lee JKT, Ang BWL, Liang CR, Tan CA, Choong DAW, Hoon HX, Ong MKL, Quek ST.J Am Coll Radiol. 2020 Apr 3. doi: 10.1016/j.jacr.2020.03.027. Online ahead of print. PMID: 32298643Free PMC article.

Burn Center Function During the COVID-19 Pandemic: An International Multi-Center Report of Strategy and Experience

Barret JP, Chong SJ, Depetris N, Fisher MD, Luo G, Moiemen N, Pham T, Qiao L, Wibbenmeyer L, Matsumura H. Burns. 2020 Apr 10:S0305-4179(20)30274-6. doi: 10.1016/j.burns.2020.04.003. Online ahead of print. PMID: 32416984Free PMC article.

Preparing Your Intensive Care Unit for the COVID-19 Pandemic: Practical Considerations and Strategies

Goh KJ, Wong J, Tien JC, Ng SY, Duu Wen S, Phua GC, Leong CK. Crit Care. 2020 May 11;24(1):215. doi: 10.1186/s13054-020-02916-4.PMID: 32393325Free PMC article. Review. 209

Infection Control

Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient

Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, Marimuthu K. JAMA. 2020 Mar 4;323(16):1610-2. doi: 10.1001/jama.2020.3227. Online ahead of print. PMID: 32129805Free PMC article.

Absence of Contamination of Personal Protective Equipment (PPE) by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Ong SWX, Tan YK, Sutjipto S, Chia PY, Young BE, Gum M, Lau SK, Chan M, Vasoo S, Mendis S, Toh BK, Leong J, Barkham T, Ang BSP, Tan BH, Leo YS, Marimuthu K, Wong MSY, Ng OT. Infect Control Hosp Epidemiol. 2020 May;41(5):614-616. doi: 10.1017/ice.2020.91. Epub 2020 Mar 26.PMID: 32213231Free PMC article. No abstract available.

Rapid Ramp-Up of Powered Air-Purifying Respirator (PAPR) Training for Infection Prevention and Control During the COVID-19 Pandemic

Chen Q, Lim B, Ong S, Wong WY, Kong YC. Br J Anaesth. 2020 Apr 15:S0007-0912(20)30218-X. doi: 10.1016/j.bja.2020.04.006. Online ahead of print.PMID: 32340733Free PMC article. No abstract available.

COVID-19 and the Risk to Health Care Workers: A Case Report

Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, Tan TY, Raghuram J. Ann Intern Med. 2020 Mar 16:L20-0175. doi: 10.7326/L20-0175. Online ahead of print.PMID: 32176257Free PMC article. No abstract available.

Preventing the Transmission of COVID-19 Amongst Healthcare Workers

Tan LF. J Hosp Infect. 2020 Apr 9:S0195-6701(20)30183-3. doi: 10.1016/j.jhin.2020.04.008. Online ahead of print. PMID: 32278703Free PMC article. No abstract available.

Paediatrics Intensive Care

Special Considerations for the Management of COVID-19 Pediatric Patients in the Operating Room and Pediatric Intensive Care Unit in a Tertiary Hospital in Singapore

Thampi S, Yap A, Fan L, Ong J. Paediatr Anaesth. 2020 Apr 8. doi: 10.1111/pan.13863. Online ahead of print. PMID: 32267047

Flash Survey on Severe Acute Respiratory Syndrome coronavirus-2 Infections in Paediatric Patients on Anticancer Treatment

Hrusak O, Kalina T, Wolf J, Balduzzi A, Provenzi M, Rizzari C, Rives S, Del Pozo Carlavilla M, Alonso MEV, Domínguez-Pinilla N, Bourquin JP, Schmiegelow K, Attarbaschi A, Grillner P, Mellgren K, van der Werff Ten Bosch J, Pieters R, Brozou T, Borkhardt A, Escherich G, Lauten M, Stanulla M, Smith O, Yeoh AEJ, Elitzur S, Vora A, Li CK, Ariffin H, Kolenova A, Dallapozza L, Farah R, Lazic J, Manabe A, Styczynski J, Kovacs G, Ottoffy G, Felice MS, Buldini B, Conter V, Stary J, Schrappe M. Eur J Cancer. 2020 Apr 7;132:11-16. doi: 10.1016/j.ejca.2020.03.021. Online ahead of print. PMID: 32305831 Free PMC article.

Coronavirus Disease 2019 in Critically Ill Children

Ong, Jacqueline S. M. MB BChir, MMed (Paeds), MRCPCH1,2; Tosoni, Alvise MD3; Kim, YaeJean MD, PhD4; Kissoon, Niranjan MB BS, FRCP(C), FAAP, MCCM, FACPE5; Murthy, Srinivas MD CM, MHSc5
Pediatric Critical Care Medicine: April 7, 2020 - Volume Online First - Issue - doi: 10.1097/PCC.000000000000237

Clinical Therapies

Role of Adjunctive Treatment Strategies in COVID-19 and a Review of International and National Clinical Guidelines

Xu X, Ong YK, Wang Y. Mil Med Res. 2020 May 5;7(1):22. doi: 10.1186/s40779-020-00251-x. PMID: 32370766 Free PMC article. Review.

Treatment of Patients With Nonsevere and Severe Coronavirus Disease 2019: An Evidence-Based Guideline

Ye Z, Rochwerg B, Wang Y, Adhikari NK, Murthy S, Lamontagne F, Fowler RA, Qiu H, Wei L, Sang L, Loeb M, Shen N, Huang M, Jiang Z, Arabi YM, Colunga-Lozano LE, Jiang L, Koh Y, Liu D, Liu F, Phua J, Shen A, Huo T, Du B, Zhai S, Guyatt GH. CMAJ. 2020 Apr 29:cmaj.200648. doi: 10.1503/cmaj.200648. Online ahead of print. PMID: 32350002No abstract available.

ICU Care of COVID-19


Reducing Droplet Spread During Airway Manipulation: Lessons From the COVID-19 Pandemic in Singapore

Au Yong PS, Chen X.Br J Anaesth. 2020 Apr 15:S0007-0912(20)30219-1. doi: 10.1016/j.bja.2020.04.007. Online ahead of print. PMID: 32312572Free PMC article. No abstract available.

Reducing Droplet Spread During Airway Manipulation. Reply to Au Yong and Colleagues (Br J Anaesth 2020, in Press)

Lim WY, Wong P, Ong SGK. Br J Anaesth. 2020 May 1:S0007-0912(20)30297-X. doi: 10.1016/j.bja.2020.04.074. Online ahead of print. PMID: 32416992 No abstract available


COVID-19 and Cardiopulmonary Resuscitation: The Recommended N95 Mask May Not Be Adequate

Wong P, Kim Ong SG, Lim WY. Br J Anaesth. 2020 May 18. doi: 10.1016/j.bja.2020.05.008. Online ahead of print. PMID: 32425209Free PMC article. No abstract available.

Rapid Training of Healthcare Staff for Protected Cardiopulmonary Resuscitation in the COVID-19 Pandemic

Foong TW, Hui Ng ES, Wee Khoo CY, Ashokka B, Khoo D, Agrawal R. Br J Anaesth. 2020 May 6:S0007-0912(20)30326-3. doi: 10.1016/j.bja.2020.04.081. Online ahead of print. PMID: 32416987Free PMC article. No abstract available.

Acute Respiratory Distress Syndrome

Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness From COVID-19 Infection

Goh KJ, Choong MC, Cheong EH, Kalimuddin S, Duu Wen S, Phua GC, Chan KS, Haja Mohideen S. Ann Acad Med Singapore. 2020 Mar 16;49(3):108-118.PMID: 32200400

Extracorporeal Membrane Oxygenation

Planning and Provision of ECMO Services for Severe ARDS During the COVID-19 Pandemic and Other Outbreaks of Emerging Infectious Diseases

Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, MacLaren G, Brodie D, Shekar K. Lancet Respir Med. 2020 May;8(5):518-526. doi: 10.1016/S2213-2600(20)30121-1. Epub 2020 Mar 20.PMID: 32203711Free PMC article. Review

Preparing for the Most Critically Ill Patients With COVID-19: The Potential Role of Extracorporeal Membrane Oxygenation

MacLaren G, Fisher D, Brodie D. JAMA. 2020 Feb 19. doi: 10.1001/jama.2020.2342. Online ahead of print. PMID: 32074258N o abstract available.

Blood Transfusion Strategies and ECMO During the COVID-19 Pandemic - Authors' Reply

Ramanathan K, MacLaren G, Combes A, Brodie D, Shekar K. Lancet Respir Med. 2020 May;8(5):e41. doi: 10.1016/S2213-2600(20)30174-0. Epub 2020 Apr 16.PMID: 32305077Free PMC article. No abstract available.