Related Experiment Video
Updated: Oct 12, 2025
Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers
Published on: March 14, 2018
A Qualitative Analysis of Observed Behavior of Pediatric Rapid Response Team Performance
Amanda B Levin1, Alexander M Cartron2, Ashley Siems3
1Department of Anesthesiology and Critical Care Medicine, Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland.
Insights
Directly observing pediatric rapid response teams (RRTs) identified factors influencing their performance. Enhancers and threats to RRT teamwork were categorized to improve patient safety and outcomes.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
- Healthcare team dynamics
Background:
- Pediatric rapid response teams (RRTs) are crucial for patient safety, aiming to prevent cardiorespiratory arrests and detect deterioration.
- Teamwork, communication, and decision-making are vital for effective RRT performance.
- Failures in these areas can negatively impact RRT outcomes.
Purpose of the Study:
- To directly observe pediatric RRT activations and identify factors influencing team performance.
- To describe enhancers and threats to RRT teamwork.
- To develop a framework for understanding RRT performance spectrum.
Main Methods:
- Direct observation of 73 in situ pediatric RRT activations.
- Collection and qualitative content analysis of field notes.
- Categorization of influencing codes as enhancers or threats, organized by themes.
- Development of a framework distinguishing orderly from chaotic RRTs.
Main Results:
- Teamwork, leadership, and patient/family factors significantly influenced RRT performance.
- Identified novel threats: indecision, disruptive behavior, shifting leadership, and patient/family distress.
- A framework was constructed to differentiate orderly and chaotic RRT characteristics.
Conclusions:
- In situ RRT observations confirmed known characteristics and revealed new aspects of team function.
- The proposed framework of enhancers and threats can guide future interventions.
- Optimizing RRT training and design based on this framework can improve performance and patient safety.
Background And Objectives:
Pediatric rapid response teams (RRTs) enhance patient safety, reduce cardiorespiratory arrests outside the PICU, and detect deteriorating patients before decompensation. RRT performance may be affected by failures in communication, poor team dynamics, and poor shared decision-making. We aimed to describe factors associated with team performance using direct observation of pediatric RRTs.
Methods:
Our team directly observed 73 in situ RRT activations, collected field notes of qualitative data, and analyzed the data using conventional content analysis. To assess accuracy of coding, 20% of the coded observations were reassessed for interrater reliability. The codes influencing team performance were categorized as enhancers or threats to RRT teamwork and organized under themes. We constructed a framework of the codes and themes, organized along a spectrum of orderly versus chaotic RRTs.
Results:
Three themes influencing RRT performance were teamwork, leadership, and patient and family factors, with underlying codes that enhanced or threatened RRT performance. Novel factors that were found to threaten team performance included indecision, disruptive behavior, changing leadership, and family or patient distress. Our framework delineating features of orderly and chaotic RRTs may be used to inform training and design of RRTs to optimize performance.
Conclusions:
Observations of in situ RRT activations in a pediatric hospital both verified previously described characteristics of RRTs and identified new characteristics of team function. Our proposed framework for understanding these enhancers and threats may be used to inform future interventions to improve RRT performance.
More Related Videos
08:22Measuring Cardiac Autonomic Nervous System ANS Activity in Toddlers - Resting and Developmental Challenges
Published on: February 25, 2016
14:05Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Related Concept Videos
02:30Naturalistic Observations
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...