Association of Adverse Events With Rapid Response Team Activations in Hospitalized Children

Adverse events (AEs) are frequent in hospitalized children and may lead to unplanned transfers to intensive care units (ICUs). ICU transfers may occur following activation of nonemergent or emergent assessments by a rapid response team (RRT). We sought to measure and characterize AEs around RRT activations and ICU transfers and whether different RRT triage mechanisms were associated with differences in AE rates or characteristics.

We performed a retrospective cohort study of hospitalized patients younger than 18 years with RRT evaluations for and transfers to ICUs. We measured AEs from hospital admission until RRT activation (pretransfer) and during the first 48 hours following ICU transfer (posttransfer). AEs identified on primary chart review underwent secondary review by 2 independent physicians who determined case classification, severity level, and preventability.

In total, 699 RRT activations were reviewed, and 407 AEs were recorded. Pretransfer AE rates were higher for patients triaged emergently vs nonemergently (0.68 vs 0.52 AE/RRT, P = .03). Most AEs pretransfer resulted in temporary harm (National Coordinating Council for Medication Error Reporting and Prevention level F, 69.7%). Most AEs were preventable pre- (53.4%) and post-ICU transfer (51.6%). The most common clinical types of AEs were related to medications/fluids (38.3%), procedures (24.8%), and diagnosis (17.4%).

We identified high rates of AEs among patients requiring ICU triage and transfer, especially among those triaged emergently. Activation of an RRT or ICU transfer is a very high-yield trigger for AE detection.