Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Humphreys, Stacey; Totapally, Balagangadhar

doi:10.4037/ajcc2016329

Cited by 19 publications

(12 citation statements)

References 29 publications

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“…We report a higher rate of unplanned PICU admission following daytime MET activation and a significant increase in the likelihood of unplanned PICU admission at 08:00, immediately following the period of lowest MET dosage overnight (00:00–07:59). 20 29 30 31 Our results suggest that important clinical deterioration may go undetected overnight in hospitalized pediatric patients leading to sicker patients by morning and consequently higher likelihood of unplanned PICU admission in the daytime. This may occur for several reasons.…”

Section: Discussionmentioning

confidence: 78%

“…Additionally, our finding of higher rates of unplanned PICU admission in the daytime is consistent with a study of 542 MET activations from Nicklaus Children's Hospital in Miami (a 289-bed pediatric hospital with a 40-bed PICU). 30 We add to their results by having examined outcomes by 1-hour intervals, which allowed us to make more specific conclusions regarding the impact of time of day. We are the first pediatric study to examine the impact of time of day on both MET dosage and patient outcomes following MET activation, while describing key relationships between the two.…”

Section: Discussionmentioning

confidence: 99%

“…However, our findings are similar to major adult studies and the only prior small pediatric studies. 20 29 30 31…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients

Feder

Ramsay

Tsampalieros

et al. 2022

J Pediatr Intensive Care

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This study was conducted to investigate whether outcomes of medical emergency team (MET) activations differ by time of day of in-hospitalized pediatric patients. This is a retrospective cohort study. Data were extracted from the charts of 846 patients (with one or more MET activations) over a 5-year period. It was conducted at Children's Hospital of Eastern Ontario, a tertiary pediatric hospital in Ottawa, Canada, affiliated with University of Ottawa. Patients included children <18 years, admitted to a pediatric ward, who experienced a MET activation between January 1, 2016 and December 31, 2020. We excluded patients reviewed by the MET during a routine follow-up, planned pediatric intensive care unit (PICU) admissions from the ward, and MET activation in out-patient settings, post-anesthesia care unit, and neonatal intensive care unit. There was no intervention. A total of 1,230 MET encounters were included as part of the final analysis. Daytime (08:00–15:59) MET activation was associated with increased PICU admission (25.3%, p = 0.04). There was some evidence of a higher proportion of critical deterioration events (CDEs) during daytime MET activation; however, this did not reach statistical significance (24%, p = 0.09). The highest MET dosage occurred during the evening hours, 16:00 to 23:59 (15/1,000 admissions), and it was lowest overnight, 00:00 to 07:59 (8.8/1,000 admissions, p < 0.001). This period of lowest MET dosage immediately preceded the highest likelihood of PICU admission (08:00, 37.5%) and CDE (09:00, 30.2%). Following the period of lowest MET activity overnight, MET activations during early daytime hours were associated with the highest likelihood of unplanned PICU admission and CDEs. This work identifies potential high-risk periods for undetected critical deterioration and targets for future quality improvement.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients

Feder

Ramsay

Tsampalieros

et al. 2022

J Pediatr Intensive Care

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“…Early ICU transfer is a considerable quality measure of emergency department care and delayed ICU admission was showed to be associated with increased mortality [18,19]. It's also reported that unplanned transfers from acute care than among other intensive care admissions had higher mortality [20]. Therefore, it's essential to describe the patients with RM transferred to an ICU from another departments since RM is a potentially dangerous medical condition that needs rapid diagnosis and management.…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis‐associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis

Decai

Zhang

et al. 2022

Internal Medicine Journal

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Background: Rhabdomyolysis (RM) associated acute kidney injury (AKI) is the most common systemic complication of RM. The present study aimed to assess the clinical characteristics and risk factors for intensive care unit (ICU) transfer for patients with RM-associated AKI.Methods: We included all patients who were age ≥ 18 years old with a diagnosis of RM from September 2012 to October 2018 and divided them into RM-associated AKI group and RM without AKI group. The primary outcome was transferring to ICU treatment. Regression analysis was performed to identify factors associated with ICU treatment and recovery of renal function.Results: Among the 149 patients with RM, 68 (45.6%) developed AKI. The percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% versus 12.3%, P < 0.002). Additionally, patients with AKI had higher percentage of undergoing dialysis (19.1% versus 2.5%, P < 0.01), all-cause mortality (13.2% versus 1.2%, P < 0.01), cost of hospitalization [10.8 1,000 yuan, IQR (5.5, 3.5) versus 5.9 1,000 yuan, IQR 5.9 (3.6, 9.9), P = 0.03], as well as longer length of hospital stay [8.0 (5.0, 14.0)] versus [6.0 (4.0, 11.0)], P = 0.02). Moreover, most patients with AKI achieved complete recovery (77.9%) at discharge. After adjusting for potential risk factors, RM-associated AKI remained an independent risk factor for ICU transfer (OR = 3.0, 95% CI, 1.11-8.3, P = 0.03). However, ICU transfer was not associated with recovery of renal function (OR = 0.88, 95% CI, 0.22-3.57, P = 0.856). Conclusion: RM leaded to AKI in most patients. RM-associated AKI could cause worse clinical outcome and predict ICU transfer for patients with RM.

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“…Hospitalized children requiring an unplanned transfer to the ICU experience worse clinical outcomes than patients admitted directly to the ICU. 1,2 To improve these outcomes, a bedside consult with a rapid response team (RRT) composed of ICU personnel is often incorporated into care escalation systems to facilitate early identification and intervention for patients outside the ICU at risk for deterioration. The use of RRTs is associated with reductions in hospital-wide mortality, codes and cardiopulmonary arrests outside of the ICU, and emergent, unplanned ICU transfers.…”

mentioning

confidence: 99%

The Association Between Fever and Subsequent Deterioration Among Hospitalized Children With Elevated PEWS

Lockwood

Reese

Wathen

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: To evaluate the association between fever and subsequent deterioration among patients with Pediatric Early Warning Score (PEWS) elevations to $4 to inform improvements to care escalation processes at our institution. METHODS:We performed a cohort study of hospitalized children at a single quaternary children's hospital with PEWS elevations to $4 between January 1, 2014 and March 31, 2014. Bivariable analysis was used to compare characteristics between patients with and without unplanned ICU transfers and critical deterioration events (CDEs) (ie, unplanned ICU transfers with life-sustaining interventions initiated in the first 12 ICU hours). A multivariable Poisson regression was used to assess the relative risk of unplanned ICU transfers and CDEs. RESULTS:The study population included 220 PEWS elevations from 176 unique patients. Of those, 33% had fever (n 5 73), 40% experienced an unplanned ICU transfer (n 5 88), and 19% experienced CDEs (n 5 42). Bivariable analysis revealed that febrile patients were less likely to experience an unplanned ICU transfer than those without fever. The same association was found in multivariable analysis with only marginal significance (adjusted relative risk 0.68; 95% confidence interval 0.45-1.01; P 5 .058). There was no difference in the CDE risk for febrile versus afebrile patients (adjusted relative risk 0.79; 95% confidence interval 0.43-1.44; P 5 .44). CONCLUSIONS:At our institution, patients with an elevated PEWS appeared less likely to experience an unplanned ICU transfer if they were febrile. We were underpowered to evaluate the effect on CDEs. These findings contributed to our recognition that (1) PEWS may not include all relevant clinical factors used for clinical decision-making regarding care escalation and (2) further study is needed in this area. the section head of pediatric hospital medicine who assisted with the study design and provided mentorship; Mr Thomas is a biostatistician who performed the statistical analysis; Ms Wathen is a clinical practice specialist in the PICU at Children' s Hospital Colorado who assisted in study design and data collection; Dr Brittan is a pediatric hospitalist who assisted with the study design and data analysis; Ms Iwanowski is a quality improvement specialist who assisted in the study design and data collection; Dr McLeod is a pediatric hospitalist who assisted with study design, assisted with data analysis, and provided mentorship; and all authors approved the final manuscript as submitted. Total PEWS, median (IQR) 4.0 (4.0-5.0) PEWS subset scores, median (IQR) Cardiovascular 1.0 (1.0-1.0) Respiratory 2.0 (1.0-3.0) Behavior 1.0 (1.0-2.0) Change from previous PEWS, median (IQR) 2.0 (1.0-3.0)Acute HHFNC, n (%) 61 (28) Continuous albuterol, n (%) 19 (9) Nighttime event, n (%) 99 (45) IQR, interquartile range.

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Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

Cited by 19 publications

References 29 publications

Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients

Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients

Rhabdomyolysis‐associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis

The Association Between Fever and Subsequent Deterioration Among Hospitalized Children With Elevated PEWS

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