Characteristics of Pediatric Rapid Response Systems: Results From a Survey of PRIS Hospitals

Abstract

BACKGROUND: Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration. OBJECTIVES: To describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network. METHODS: We developed the survey through a series of prospective respondent, expert, and cognitive interviews. One institutional expert per PRIS hospital (n = 109) was asked to complete the web survey. We summarized responses using descriptive statistics with a secondary analysis of univariate associations between RRS characteristics and perceived effectiveness. RESULTS: The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. Many hospitals used an early warning score (77%) for identification with variable characteristics (46% automated versus 54% full or partially manual calculation; inputs included vital signs [98%], physical examination findings [88%], diagnoses [23%], medications [19%], and diagnostic tests [14%]). Few incorporated a validated prediction model (9%). Similarly, many RRSs used a rapid response team for intervention (93%) with variable team composition (respiratory therapists [94%], ICU nurses [93%], ICU providers [67%], and pharmacists [27%]). Some used the early warning score to trigger the rapid response team (50%). Only a few staffed a clinician to proactively surveil hospitalized children for risk of deterioration (18%), and these tended to be larger hospitals (annual admissions 12 000 vs 6000, P = .007). Most responding experts stated their RRSs improved patient outcomes (92%). CONCLUSIONS: RRS characteristics varied across PRIS hospitals.

Causal impact of the Pediatric Rapid Response Team's actions on the reduction of unplanned PICU admissions and non-ICU cardiorespiratory arrest: Using the Google Causal Impact R Package.

“…[33][34][35][36][37] Furthermore, sepsis (105/471, 22.30%) is the second most prevalent cause, with a higher incidence reported by White K, Scott IA, and other s co-workers (2016) at 29.5%, %, [38] a lower rate than ours at 16.1%, [33] and a higher incidence reported by Lockwood JM, Ziniel SI, and Bona de CP (2021) at 44%. [39] The pediatric rapid response team is an excellent tool for initiating early goal-directed therapy for sepsis and lowering sepsis-related mortality. [40] Crossing the Quality Chasm, a 2001 publication, encourages healthcare professionals and policymakers to implement new system methodologies and ideas to accomplish change.…”

Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review

“…Of these, only three studies (Martinez et al, 2018;Meulmester et al, 2018Meulmester et al, , 2021 directly measured the RRT triggers. The remaining five studies (Jayaram et al, 2017;Kolovos et al, 2018;Kun et al, 2019;Lockwood et al, 2021;McKelvie et al, 2017) reported on triggers as their secondary outcomes.…”

Clinical progress note: Situation awareness for clinical deterioration in hospitalized children

“…Finally, proactive surveillance teams, while relatively uncommon in the United States, represent another strategy to enhance the afferent arm of the RRS 8 . Comprised variably of staff from the intensive care unit (ICU) or the ward, surveillance teams—which may be multidisciplinary—are designed to augment the resources of the ward team in promoting early recognition of clinical deterioration 8 . However, the impact of this care model on patient outcomes is not yet known.…”

“…8 Comprised variably of staff from the intensive care unit (ICU) or the ward, surveillance teams-which may be multidisciplinary-are designed to augment the resources of the ward team in promoting early recognition of clinical deterioration. 8 However, the impact of this care model on patient outcomes is not yet known. Active innovation in the electronic health record and embedded software applications focuses on dashboards and data visualizations showing risk status (e.g., "watcher" activations) or trends in PEWS.…”