Abstract
Objective
To report our experience before and after implementation of pediatric rapid response team (RRT) in pediatric wards of a tertiary care hospital in Pakistan.
Methods
An audit of RRT activity from December 2007 to August 2008 was conducted and reviewed patient diagnoses at the time of call placement, interventions done and post-intervention clinical outcomes. Clinical Outcomes in the nine months before RRT implementation were compared with those in the first operational nine months after RRT.
Results
Eighty-three calls were generated during the post-intervention study period of 9-month (21 calls/1000 admissions). The median age of patients was 27 months; 37% calls were for infants. The majority of patients were under care of medical services (93% vs 7% under care of surgical services). Greater numbers of calls were made during 0800–1600 hours (45%). Respiratory issues were the most common reason for activation of RRT. Because of early interventions, majority (61%) of patients avoided unnecessary PICU stay and expenditure; only 17% required mechanical ventilation in PICU. The code rate per 1000 admissions decreased from 5.2 (pre-RRT) to 2.7 (post-RRT) (p=0.08; OR 1.88(95%Cl 0.9 −3.93). The mortality rate of patients admitted in PICU from wards decreased from 50% to 15% (p=0.25; OR 1.64 (95%Cl 0.63–4.29).
Conclusion
Our experience with implementation of RRT was associated with reduction in cardiorespiratory arrest, mortality and saved a lot of PICU resource utilization. It is an excellent patient-safety initiative especially in resource-constrained countries by bringing PICU reflexes outside the PICU.
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References
Franklin C, Mathew J. Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med 1994; 22: 244–247.
Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 1990; 98:1388–1392.
Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, Norman SL et al. Antecedents to hospital deaths. Intern Med J 2001; 31: 343–348.
Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 1998; 26:1337–1345.
Sax FL, Charlson ME. Medical patients at high risk for catastrophic deterioration. Crit Care Med 1987; 15: 510–515.
Tibballs J, van der Jagt EW. Medical emergency and rapid response teams. Pediatr Clin North Am 2008; 55: 989–1010
Winberg H, Nilsson K, Aneman A. Paediatric Rapid Response Systems: a literature review. Acta Anaesthesiol Scand 2008; 52: 890–896.
Berg MD, Nadkarni VM, Zuercher M, Berg RA. In-hospital cardiac arrest. Pediatr Clin North Am 2008; 55: 589–604
Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295: 324–327.
Institute of Health Care Improvement (IHI) 2006. How to guide pediatric supplement Rapid Response Team; http://www.ihi.org. Accessed on 10 February 2009
VandenBerg SD, Hutchison JS, Parshuram CS. A crosssectional survey of levels of care and response mechanisms for evolving critical illness in hospitalized children. Pediatrics 2007; 119: e940–e946.
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H et al. A prospective before-and-after trial of a medical emergency team. Med J Aust 2003; 179: 283–287.
Baxter AD, Cardinal P, Hooper J, Patel R. Medical emergency teams at The Ottawa Hospital: the first two years. Can J Anaesth 2008; 55: 223–231.
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002; 324: 387–390.
Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med 2007; 35: 2076–2082.
Tibballs J, Kinney S, Duke T, Oakley E, Hennessy M. Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child 2005; 90: 1148–1152.
Brilli RJ, Gibson R, Luria JW et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med 2007; 8: 236–246.
Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J et al. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children’s Hospital. JAMA 2007; 298: 2267–2274.
Mistry KP, Turi J, Hueckel R, Mericle J, Meliones JN. Pediatric Rapid Response Teams in the Academic Medical Centre. Clin Ped Emerg Med 2006; 7: 241–247.
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Anwar-ul-Haque, Saleem, A.F., Zaidi, S. et al. Experience of pediatric rapid response team in a tertiary care hospital in Pakistan. Indian J Pediatr 77, 273–276 (2010). https://doi.org/10.1007/s12098-010-0032-2
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DOI: https://doi.org/10.1007/s12098-010-0032-2