Retrospective review of emergency response activations during a 13‐year period at a tertiary care children's hospital

Wang, George Sam; Erwin, Nicole; Zuk, Jeannie; Henry, Desmond B.; Dobyns, Emily L.

doi:10.1002/jhm.832

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…Our results are similar to those of Wang et al, 8 who found that emergency response teams for resuscitation were called more often during the daytime hours. In a study in adult patients, Jones et al, 5 found that more calls were made during the change of nursing shifts.…”

Section: Discussionsupporting

confidence: 92%

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

Humphreys

Totapally

2016

American Journal of Critical Care

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Background Variability in disposition of children according to the time of rapid response calls is unknown. Objective To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care. Methods Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit. Results Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P < .001) than among other intensive care patients (1.4%). Conclusion Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.

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Section: Discussionsupporting

confidence: 92%

“…In a study by Wang et al, 8 a higher number of rapid responses were called during the day shift (6 am-6 pm) than during the night shift. In contrast, Jones et al 5 reported that more rapid responses were called during the night shift.…”

mentioning

confidence: 95%

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

Humphreys

Totapally

2016

American Journal of Critical Care

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“…Pediatric case series have suggested that younger children and those with chronic illnesses are more likely to require assistance from a medical emergency team, [11][12] but this is the first study to measure their association with this outcome in children.…”

Section: Discussionmentioning

confidence: 97%

Development of a score to predict clinical deterioration in hospitalized children

Bonafide

Holmes

Lin

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Identification of the characteristics that put hospitalized children at high risk of deterioration may help to target patients whose physiologic status should be intensively monitored for signs of deterioration, and reduce unnecessary monitoring in patients at very low risk. Previous studies have evaluated vital sign‐based early warning scores to detect deterioration that has already begun.OBJECTIVE:To develop a predictive score for deterioration using non‐vital sign patient characteristics in order to risk‐stratify hospitalized children before signs of deterioration are detectable.DESIGN:Case‐control study.SETTING:A 460‐bed children's hospital.PATIENTS:Cases (n = 141) were children who deteriorated while receiving care on non‐intensive care unit (non‐ICU) inpatient units. Controls (n = 423) were randomly selected.MEASUREMENTS:The exposures were complex chronic conditions, other patient characteristics, and laboratory studies. The outcome was clinical deterioration, defined as cardiopulmonary arrest, acute respiratory compromise, or urgent ICU transfer.RESULTS:The 7‐item score included age <1 year, epilepsy, congenital/genetic conditions, history of transplant, enteral tube, hemoglobin <10 g/dL, and blood culture drawn in the preceding 72 hours. We grouped the patients into risk strata based on their scores. The very low‐risk group's probability of deterioration was less than half of baseline risk. The high‐risk group's probability of deterioration was more than 80‐fold higher than the baseline risk.CONCLUSIONS:We identified a set of characteristics associated with clinical deterioration in children. Used in combination as a score, these characteristics may be useful in triaging the intensity of monitoring and surveillance for deterioration that children receive while hospitalized on non‐ICU units. Journal of Hospital Medicine 2012;

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“…4 There is mixed evidence on the efficacy of pediatric RR teams, particularly for the reduction in hospital mortality. 5 Several studies demonstrate that the use of RR teams has been associated with improved outcomes such as reductions in rates of respiratory arrest and code events [6][7][8][9] ; meta-analyses have indicated that RR teams are associated with reduced rates of cardiorespiratory arrest outside of the ICU and reduced mortality in both adult and pediatric populations. [10][11][12] In children, implementation of a RR team was associated with a 37.7% reduction in rates of cardiorespiratory arrest outside of the ICU, and a 21.4% reduction in hospital mortality rates.…”

Section: Introductionmentioning

confidence: 99%

“…14,15 Younger children with a chronic disease and various comorbidities may have benefitted from planning, placement, and early ICU intervention afforded by RR events. 6 Previous studies have examined RR events in pediatric in-patient units by examining child diagnoses, interventions, and post-intervention clinical outcomes and placement, 16 but there have not been any studies focusing on children on HMV. The incidence, demographic information, clinical presentation, and outcomes of RR/code events among children on HMV in a non-ICU respiratory care unit are not well known.…”

Section: Introductionmentioning

confidence: 99%

Rapid Response and Code Events in Hospitalized Children on Home Mechanical Ventilation

et al. 2019

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BACKGROUND: There is limited knowledge of rapid-response (RR) events and code events for children receiving home mechanical ventilation (HMV) via a tracheostomy in a non-ICU respiratory care unit. The purpose of this study was to describe the demographic and clinical factors leading to deterioration among these children and to identify the incidence and outcomes following rapid-response and code events. METHODS: A retrospective review was conducted on hospitalized HMV children who had RR/code events in a non-ICU respiratory care unit. RESULTS: There were a total of 50 RR events, and the primary clinical problem was acute respiratory distress, with 27 subjects (54%) needing ventilator adjustments. Twenty (40%) RR events occurred among children who were awaiting initial home discharge. Of 18 total code events, 7 (39%) children needed a tracheostomy-related intervention. There were 10 (56%) codes among children on mechanical ventilation awaiting initial home discharge. Children on HMV had 8.73 RR events per 1,000 patient days, whereas all other hospitalized children had 4.61 RR events per 1,000 patient days. In addition, children on HMV had 3.14 codes per 1,000 patient days, whereas all other hospitalized children had 0.74 codes per 1,000 patient days. All children were discharged from the hospital, and no deaths were associated with RR/code events for the index hospitalization. CONCLUSIONS: The overall incidence of RR/code events in children on HMV was higher than among non-HMV hospitalized children. Children on HMV preparing for their initial hospital discharge had the greatest number of RR/code events. The most prevalent interventions among children with RR events were ventilator setting adjustments, and among children with codes the most frequent actions were tracheostomy-related interventions. Developing strategies to predict risk factors for RR/code events may help decrease harm among children on HMV.

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Retrospective review of emergency response activations during a 13‐year period at a tertiary care children's hospital

Cited by 8 publications

References 12 publications

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

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

Development of a score to predict clinical deterioration in hospitalized children

Rapid Response and Code Events in Hospitalized Children on Home Mechanical Ventilation

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