Longitudinal Evaluation of a Pediatric Rapid Response System with Realist Evaluation Framework

Area of Science:

• Pediatric critical care
• Healthcare quality improvement
• Systems engineering in medicine

Background:

• Rapid response (RR) systems are crucial for patient outcomes, but their effectiveness is influenced by institutional factors.
• This study utilized a realist evaluation framework to assess a pediatric RR system, focusing on significant events termed REACT (Rapid Escalation After Critical Transfer).

Purpose of the Study:

• To evaluate the impact of a pediatric rapid response system using a realist evaluation framework.
• To decrease REACT events, defined by specific clinical interventions within 24 hours of an RR, by 25% over three years.
• To identify and address mechanistic and contextual deficiencies within the RR system, particularly those related to crisis resource management (CRM).

Main Methods:

• Applied the realist evaluation (context-mechanism-outcomes) framework to review REACT events.
• Employed a continuous quality improvement process for identifying, debriefing, and reviewing REACT events.
• Categorized RR system deficiencies into CRM themes to guide targeted interventions.

Main Results:

• Over five years, REACT events with CRM gaps decreased from 62.3% to 26.5%.
• The proportion of REACTs with multiple deficiencies reduced from 72.5% to 23.2%.
• Cardiopulmonary arrests (CPAs) outside the Intensive Care Unit (ICU) decreased from 15 to 3 per year, indicating improved patient stabilization.

Conclusions:

• The realist evaluation framework provided a comprehensive assessment of the RR system.
• Reviewing REACT events proved feasible and sustainable, offering valuable insights for system-wide enhancements.
• The study successfully guided improvements in RR system activation, processes, management, hospital resources, policies, and training.