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Characteristics of Pediatric Rapid Response Systems: Results From a Survey of PRIS Hospitals
Justin M Lockwood1,2, Sonja I Ziniel3, Christopher P Bonafide4
1Department of Pediatrics, Section of Hospital Medicine, School of Medicine, University of Colorado, Aurora, Colorado; justin.lockwood@childrenscolorado.org.
Insights
Rapid response systems (RRSs) in children
Area of Science:
- Pediatric critical care
- Hospital quality improvement
- Patient safety systems
Background:
- Rapid response systems (RRSs) are crucial for identifying and intervening in deteriorating hospitalized children.
- Variability in RRS implementation can impact effectiveness.
Purpose of the Study:
- To characterize RRS features across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network.
- To understand the diversity in RRS identification methods, team composition, and proactive surveillance.
Main Methods:
- A web survey was administered to institutional experts at 109 PRIS network hospitals.
- Descriptive statistics summarized RRS characteristics; univariate analyses explored associations with perceived effectiveness.
Main Results:
- The survey achieved a 72% response rate, with diverse hospital types represented.
- Most RRSs utilized early warning scores (77%) with varied calculation methods and inputs (vital signs, exam findings).
- Rapid response teams (93%) had diverse compositions (respiratory therapists, ICU nurses, ICU providers, pharmacists).
- Proactive surveillance was uncommon (18%), more frequent in larger hospitals.
- A high percentage of experts (92%) believed their RRS improved patient outcomes.
Conclusions:
- Significant variability exists in RRS characteristics, including identification methods, team composition, and intervention triggers, across pediatric hospitals.
- Despite variations, most experts perceive RRSs as beneficial for patient outcomes.
Background:
Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration.
Objectives:
To describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network.
Methods:
We developed the survey through a series of prospective respondent, expert, and cognitive interviews. One institutional expert per PRIS hospital (n = 109) was asked to complete the web survey. We summarized responses using descriptive statistics with a secondary analysis of univariate associations between RRS characteristics and perceived effectiveness.
Results:
The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. Many hospitals used an early warning score (77%) for identification with variable characteristics (46% automated versus 54% full or partially manual calculation; inputs included vital signs [98%], physical examination findings [88%], diagnoses [23%], medications [19%], and diagnostic tests [14%]). Few incorporated a validated prediction model (9%). Similarly, many RRSs used a rapid response team for intervention (93%) with variable team composition (respiratory therapists [94%], ICU nurses [93%], ICU providers [67%], and pharmacists [27%]). Some used the early warning score to trigger the rapid response team (50%). Only a few staffed a clinician to proactively surveil hospitalized children for risk of deterioration (18%), and these tended to be larger hospitals (annual admissions 12 000 vs 6000, P = .007). Most responding experts stated their RRSs improved patient outcomes (92%).
Conclusions:
RRS characteristics varied across PRIS hospitals.
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