One of the key components of the Institute for Healthcare Improvement’s 100,000 Lives campaign was developing rapid response systems. The adult data regarding their effectiveness is equivocal. There is paucity in the literature with respect to pediatric rapid response team (PRRT) impact on cardiopulmonary arrest rates, pediatric intensive care unit transfers and mortality. This study describes the impact of a pediatric rapid response team on rates of inpatient cardiopulmonary arrest and transfers to elevated levels of care.
This pre and postintervention study spanned all consecutive admissions to a regional tertiary care children’s hospital over a two year period (June 2009 to July 2011). The preintervention period spanned June 2009 to September 2010; the postintervention period from October 2010 to July 2011. A multidisciplinary root cause analysis was the intervention performed in October 2010 to improve utilization of the PRRT. An enterprisewide education program, spearheaded by floor nurses resulted from the root cause analysis. PRRT calls, transfers to the pediatric intensive care unit (PICU), and number of cardiopulmonary arrests on the inpatient unit were gathered from medical records while monthly admissions and bed days were obtained from financial records. Rates of PRRT usage per 1,000 admissions, cardiopulmonary arrests per 1,000 admissions and PICU transfer rates related to PRRT calls were calculated. Pre and postintervention rate differences were compared using Poisson regression.
We obtained data from 14154 consecutive admissions to a regional tertiary care children’s hospital. Both pre and postintervention groups contained winter seasons, traditionally the period of highest patient volumes and acuity. After the root cause analysis in October 2010, the rate of calls to the PRRT increased by 106% from 6.08 to 12.56 calls/1000 admissions (rate difference = 6.48; P = 0.0001; 95% CI = 3.289.68). In contrast, the rate of floor cardiopulmonary arrests decreased by 66% from 0.59 to 0.20 events/1,000 admissions (rate difference = 0.39; P < 0.0001; 95% CI = 0.220.56). The rate of transfer to the PICU related to PRRT activation also decreased from 48.1 to 34.4% (rate difference = 13.7; P < 0.0001; 95% CI = 8.119.3).
A PRRT can make a significant positive impact on both cardiopulmonary arrest rates in inpatient care areas, as well as PICU transfers related to PRRT activations. The trend of increasing PRRT usage resulted in both decreased cardiopulmonary arrests outside the PICU as well as fewer transfers to the PICU when the PRRT was called. This demonstrates that the interventions of the PRRT were preventing elevation of care and further patient deterioration, regardless of time of year or seasonal variation in disease prevalence.
To cite this abstract:Latham B, Maul E, Russell L, Heck S. Reducing Cardiopulmonary Arrests and Intensive Care Transfers Using a Pediatric Rapid Response Team. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97614. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/reducing-cardiopulmonary-arrests-and-intensive-care-transfers-using-a-pediatric-rapid-response-team/. Accessed September 18, 2019.