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Reduction in Mortality Following Pediatric Rapid Response Team Implementation*

Kolovos, Nikoleta, S., MD1; Gill, Jeff, PhD, MBA2,3,4; Michelson, Peter, H., MD, MS1; Doctor, Allan, MD1; Hartman, Mary, E., MD, MPH1

Pediatric Critical Care Medicine: May 2018 - Volume 19 - Issue 5 - p 477–482
doi: 10.1097/PCC.0000000000001519
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Objective: To evaluate the effectiveness of a physician-led rapid response team program on morbidity and mortality following unplanned admission to the PICU.

Design: Before-after study.

Setting: Single-center quaternary-referral PICU.

Patients: All unplanned PICU admissions from the ward from 2005 to 2011.

Interventions: The dataset was divided into pre- and post-rapid response team groups for comparison.

Measurements and Main Results: A Cox proportional hazards model was used to identify the patient characteristics associated with mortality following unplanned PICU admission. Following rapid response team implementation, Pediatric Risk of Mortality, version 3, illness severity was reduced (28.7%), PICU length of stay was less (19.0%), and mortality declined (22%). Relative risk of death following unplanned admission to the PICU after rapid response team implementation was 0.685.

Conclusions: For children requiring unplanned admission to the PICU, rapid response team implementation is associated with reduced mortality, admission severity of illness, and length of stay. Rapid response team implementation led to more proximal capture and aggressive intervention in the trajectory of a decompensating pediatric ward patient.

1Department of Pediatric, Washington University in St. Louis, St. Louis, MO.

2Department of Surgery, Washington University in St. Louis, St. Louis, MO.

3Department of Political Science, Washington University in St. Louis, St. Louis, MO.

4Department of Biostatistics, Washington University in St. Louis, St. Louis, MO.

*See also p. 501.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Doctor’s institution received funding from the National Institutes of Health, the Department of Defense, and the Children’s Discovery Institute, and he received funding from Biogen and equity from Kilobyte (no payment). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: kolovos_n@kids.wustl.edu

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies