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Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children's Hospital
Paul J Sharek1, Layla M Parast, Kit Leong
1Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA. psharek@lpch.org
Insights
Implementing a rapid response team (RRT) significantly reduced hospital-wide mortality and code rates in pediatric patients outside the ICU. This study demonstrates the effectiveness of RRTs in improving pediatric patient safety and outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Hospital Quality Improvement
- Patient Safety
Background:
- Rapid Response Teams (RRTs) have proven effective in reducing mortality and cardiopulmonary arrests in adult inpatients outside the Intensive Care Unit (ICU).
- However, evidence for similar benefits in pediatric inpatients has been lacking.
- This study addresses the gap in understanding RRT effectiveness in pediatric settings.
Purpose of the Study:
- To evaluate the impact of implementing an RRT on hospital-wide mortality rates.
- To assess the effect of RRT implementation on code rates (cardiac and respiratory arrests) occurring outside the ICU.
- To determine the effectiveness of RRTs in a quaternary care academic children's hospital setting.
Main Methods:
- A historical control cohort study design was employed at a 264-bed children's hospital.
- Data from 22,037 admissions (pre-RRT) and 7,257 admissions (post-RRT) were analyzed.
- The RRT comprised pediatric ICU-trained physicians, nurses, respiratory therapists, and nursing supervisors, activated by standardized criteria.
Main Results:
- A statistically significant 18% decrease in the mean monthly mortality rate was observed post-RRT implementation (P = .007).
- Mean monthly code rates significantly decreased by over 71% per 1000 admissions and per 1000 patient-days (P = .008 and P = .007, respectively).
- Post-intervention code rates were approximately 0.29 times the pre-intervention rates per 1000 admissions and 0.28 times per 1000 patient-days.
Conclusions:
- The implementation of a Rapid Response Team (RRT) was associated with a significant reduction in hospital-wide mortality rates among pediatric inpatients.
- RRT implementation also led to a statistically significant decrease in code rates outside the pediatric ICU.
- These findings support the widespread adoption of RRTs to enhance safety and outcomes in pediatric care.
Context:
Introduction of a rapid response team (RRT) has been shown to decrease mortality and cardiopulmonary arrests outside of the intensive care unit (ICU) in adult inpatients. No published studies to date show significant reductions in mortality or cardiopulmonary arrests in pediatric inpatients.
Objective:
To determine the effect on hospital-wide mortality rates and code rates outside of the ICU setting after RRT implementation at an academic children's hospital.
Design, Setting, And Participants:
A cohort study design with historical controls at a 264-bed, free-standing, quaternary care academic children's hospital. Pediatric inpatients who spent at least 1 day on a medical or surgical ward between January 1, 2001, and March 31, 2007, were included. A total of 22,037 patient admissions and 102,537 patient-days were evaluated preintervention (before September 1, 2005), and 7257 patient admissions and 34,420 patient-days were evaluated postintervention (on or after September 1, 2005).
Intervention:
The RRT included a pediatric ICU-trained fellow or attending physician, ICU nurse, ICU respiratory therapist, and nursing supervisor. This team was activated using standard criteria and was available at all times to assess, treat, and triage decompensating pediatric inpatients.
Main Outcome Measures:
Hospital-wide mortality rates and code (respiratory and cardiopulmonary arrests) rates outside of the ICU setting. All outcomes were adjusted for case mix index values.
Results:
After RRT implementation, the mean monthly mortality rate decreased by 18% (1.01 to 0.83 deaths per 100 discharges; 95% confidence interval [CI], 5%-30%; P = .007), the mean monthly code rate per 1000 admissions decreased by 71.7% (2.45 to 0.69 codes per 1000 admissions), and the mean monthly code rate per 1000 patient-days decreased by 71.2% (0.52 to 0.15 codes per 1000 patient-days). The estimated code rate per 1000 admissions for the postintervention group was 0.29 times that for the preintervention group (95% likelihood ratio CI, 0.10-0.65; P = .008), and the estimated code rate per 1000 patient-days for the postintervention group was 0.28 times that for the preintervention group (95% likelihood ratio CI, 0.10-0.64; P = .007).
Conclusion:
Implementation of an RRT was associated with a statistically significant reduction in hospital-wide mortality rate and code rate outside of the pediatric ICU setting.
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