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Implementation of a multicenter rapid response system in pediatric academic hospitals is effective
Afrothite Kotsakis1, Anna-Theresa Lobos, Christopher Parshuram
1FRCP(C), Hospital for Sick Children, Department of Critical Care Medicine, 555 University Ave Toronto, Ontario, Canada M5G 1X8. afrothite.kotsakis@sickkids.ca
Insights
A pediatric rapid response system (PRRS) implemented across four centers did not reduce cardiopulmonary arrests. However, this physician-led team approach did decrease pediatric intensive care unit mortality after readmission.
Area of Science:
- Pediatric critical care medicine
- Healthcare systems research
- Patient safety
Background:
- Pediatric rapid response systems (PRRS) aim to improve outcomes for critically ill children.
- Evaluating the effectiveness of PRRS, particularly physician-led teams, is crucial for optimizing pediatric critical care.
- Standardized implementation across multiple centers is key to assessing PRRS impact.
Purpose of the Study:
- To assess the effectiveness of a physician-led pediatric rapid response system (PRRS) in reducing actual cardiopulmonary arrests.
- To evaluate the impact of PRRS on pediatric intensive care unit (PICU) readmission rates and mortality following readmission.
- To determine the effect of PRRS on urgent PICU admissions.
Main Methods:
- A prospective, observational study was conducted across 4 pediatric academic centers in Ontario, Canada.
- A standardized PRRS was implemented, with teams responding to activations and following discharged PICU patients for 48 hours.
- Outcomes were compared between a 2-year period post-implementation and a 2-year period pre-implementation.
Main Results:
- The PRRS implementation was not associated with a significant reduction in actual cardiopulmonary arrests (1.9 vs 1.8 per 1000 admissions; P=.68).
- There was no significant decrease in PICU mortality after urgent admission (1.3 vs 1.1 per 1000 admissions; P=.25).
- A statistically significant reduction in PICU mortality rate after readmission was observed (0.3 vs 0.1 per 1000 admissions; P=.05).
Conclusions:
- A multicenter, standardized pediatric rapid response system (PRRS) demonstrated a reduction in PICU mortality after readmission.
- The PRRS, utilizing a physician-led team, did not significantly decrease the rate of actual cardiopulmonary arrests.
- Further research may be needed to optimize PRRS interventions for preventing critical events in pediatric patients.
Objectives:
This is the first large multicenter study to examine the effectiveness of a pediatric rapid response system (PRRS). The primary objective was to determine the effect of a PRRS using a physician-led team on the rate of actual cardiopulmonary arrests, defined as an event requiring chest compressions, epinephrine, or positive pressure ventilation. The secondary objectives were to determine the effect of PRRSs on the rate of PICU readmission within 48 hours of discharge and PICU mortality after readmission and urgent PICU admission.
Methods:
A PRRS was developed, implemented, and evaluated in a standardized manner across 4 pediatric academic centers in Ontario, Canada. The team responded to activations for inpatients and followed patients discharged from the PICU for 48 hours. A 2-year, prospective, observational study was conducted after implementation, and outcomes were compared with data collected 2 years before implementation.
Results:
After PRRS implementation, there were 55 963 hospital admissions and a team activation rate of 44 per 1000 hospital admissions. There were 7302 patients followed after PICU discharge. Implementation of the PRRS was not associated with a reduction in the rate of actual cardiopulmonary arrests (1.9 vs 1.8 per 1000 hospital admissions; P=.68) or PICU mortality after urgent admission (1.3 vs 1.1 per 1000 hospital admissions; P=.25). There was a reduction in the PICU mortality rate after readmission (0.3 vs 0.1 death per 1000 hospital admissions; P=.05).
Conclusion:
The standardized implementation of a multicenter PRRS was associated with a decrease in the rate of PICU mortality after readmission but not actual cardiopulmonary arrests.
