A Cross-sectional Survey of Levels of Care and Response Mechanisms for Evolving Critical Illness in Hospitalized Children

VandenBerg, Stephanie; Hutchison, Jamie; Parshuram, Christopher S.

doi:10.1542/peds.2006-0852

Cited by 37 publications

(25 citation statements)

References 25 publications

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“…Rapid response teams (RRTs) have been put in place at many hospitals to respond to these emergencies. [1][2][3] This departure from usual chain-of-command for medical care is intended to ensure that clinically deteriorating patients receive assistance before their conditions are an emergency. Although there has been evidence of significant decreases in cardiopulmonary code (code blue) rates outside the ICU and deaths as a result of RRT implementation, they have not been eliminated.…”

mentioning

confidence: 99%

Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration

Akre¹,

Finkelstein²,

et al. 2010

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mentioning

confidence: 99%

Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration

Akre¹,

Finkelstein²,

et al. 2010

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“…1 In 2007, a cross-sectional telephone survey of 181 eligible pediatric hospitals in Canadian and America hospitals found that 55% had an IMCU. 2 IMCUs in pediatrics have been described as caring for "Patients with a low risk of, but potential for, significant deterioration." 3 This article noted that frequent monitoring of vital signs and nursing interventions were the added benefit of patient placement in an IMCU.…”

Section: Resultsmentioning

confidence: 99%

“…15,16 Interestingly, we found IMCUs in only 17% of responding institutions, which is significantly lower than the 33% and 55% noted in the literature previously. 1,2 This is possibly a result of our query, which asked for triage practices for patients presenting in the emergency department, and thus would not capture any IMCUs that act exclusively as step-down units to ICUs. The survey did not explore triage of patients within the ICU to intermediate care status or onto teams specifically designed to care for moderate acuity patients.…”

Section: Discussionmentioning

confidence: 99%

Triage of Intermediate-Care Patients in Pediatric Hospitals

Russ

Agus

2015

Hospital Pediatrics

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BACKGROUND: Hospitalized children have a wide range of acuity and risk of decompensation. The objective of this study was to determine where pediatric patients are triaged when they present to pediatric hospitals needing intense monitoring and nursing care, but do not require invasive monitoring or technology. METHODS: We completed a telephone survey of pediatric hospitals in the United States with at least 2 non-neonatal pediatric wards and at least 50 acute inpatient beds. The survey consisted of a brief scripted portrayal of 6 hypothetical patients who may be admitted to a hospital's general floor, ICU, or an intermediate care unit (IMCU). The scenarios included severe asthma, bronchiolitis, croup, diabetic ketoacidosis, and patients dependent on home ventilation via noninvasive interface or tracheostomy. The hospital bed coordinator or emergency department charge nurse was asked where each hypothetical patient would be admitted in their hospital. RESULTS: A total192 hospitals met inclusion criteria and 164 hospitals (85%) responded. For all of the scenarios, most of the institutions triaged them to the PICU. Twenty-eight (17%) of the responding institutions triaged at least 1 of the patient scenarios to an IMCU. The presence of an IMCU decreased triage to the ICU for all scenarios when comparing hospitals with and without an IMCU (P < .001). CONCLUSIONS: Inpatient triage practices among pediatric hospitals vary widely for patients who require intense nursing or frequent monitoring due to specific acute illnesses or respiratory technologies. Institutions that have an IMCU available are less likely to send these patients to the ICU.

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“…Embedding aggregate EWS within the medical record makes it easier for clinicians to see abnormal trends but validity is threatened by miscalculations and incomplete or delayed observations [9,12]. The prevalence of pediatric EWS in the UK and USA has increased from~20 % in 2005 to 80 % in 2012 [22][23][24].…”

Section: Early Warning Scoresmentioning

confidence: 99%

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

Levin

Brady

Duncan

et al. 2015

Curr Treat Options Peds

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Opinion statementRapid response systems (RRSs) aim to identify deteriorating hospitalized patients outside of the intensive care unit, respond quickly, and escalate to a higher level of care if needed. Despite a decade of evaluation, how to best design an RRS is still under study and debate. When considering your RRS, our recommendation is to start with the outcomes: what improvements in patient care are most needed in your environment? These may include reducing cardiac arrest or mortality, reducing critical deterioration, reducing length of stay in intensive care, or avoiding all preventable patient harm. Then, select a strategy for identification of at-risk patients, a response team structure that meets your institution's needs, and a quality improvement and governance structure to ensure you monitor process and outcome variables. The identification limb detects at-risk patients. For this, we recommend an aggregate pediatric early warning score (EWS), clear guidance regarding monitoring type and frequency, flagging of diagnostic risk factors, and a mandatory escalation system that uses the expertise of nurses, patients, and families and works around barriers to enhance response team activation. The structure and function of the response limb are also dependent upon the needs of the institution. We recommend a multidisciplinary team with the skills and resources to assess and manage emergencies. Proactive identification through a rover team or scheduled safety huddles may help with earlier identification of at risk patients. The quality improvement and governance structure should be designed around the desired outcomes. Regular monitoring and review of successes, near misses, and failures are vital for the system to improve outcomes.

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A Cross-sectional Survey of Levels of Care and Response Mechanisms for Evolving Critical Illness in Hospitalized Children

Cited by 37 publications

References 25 publications

Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration

Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration

Triage of Intermediate-Care Patients in Pediatric Hospitals

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

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