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To investigate the impact of delay in rapid response call (RRC) activation on Hospital mortality.This study was conducted in a university affiliated hospital providing medical, surgical, mental health, maternity, and pediatric services. RRCs were considered delayed if RRC activation was delayed by ≥ 15 min. The primary outcome measure was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), requirement of ICU admission, as well as requirement of mechanical ventilation and ICU LOS for patients requiring ICU admission.A total of 826 RRCs occurred in 629 patient admissions. A quarter of all RRCs were delayed by ≥ 15 min, with a median delay of 1 h and 20 min. Patients with a delayed RRC had significantly higher in-hospital mortality (34.7% vs. 21.2%; p = 0.001,) and significantly longer hospitalizations (11.6 vs. 8.4 days; p = 0.036). After adjusting for confounders, RRC activation was independently associated with increased in-hospital mortality (OR = 1.79; 95% CI = 1.17–2.72: p = 0.007).A delay of ≥ 15 min was associated with significantly increased in-hospital mortality and longer hospitalization. The factors contributing to the observed increase in mortality with delayed RRCs require further exploration.Delay in rapid response call activation is common even in mature rapid response systems.A delay in rapid response call activation is associated with poorer patient outcomes.Factors contributing to delay in rapid response call activation and observed increase in mortality require further exploration.