Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

Amanda Levin, Patrick Brady, Heather P. Duncan, Aisha Barber Davis

Research output: Contribution to journalReview article

Abstract

Rapid response systems (RRSs) aim to identify deteriorating hospitalized patients outside of the intensive care unit, respond quickly, and escalate to a higher level of care if needed. Despite a decade of evaluation, how to best design an RRS is still under study and debate. When considering your RRS, our recommendation is to start with the outcomes: what improvements in patient care are most needed in your environment? These may include reducing cardiac arrest or mortality, reducing critical deterioration, reducing length of stay in intensive care, or avoiding all preventable patient harm. Then, select a strategy for identification of at-risk patients, a response team structure that meets your institution’s needs, and a quality improvement and governance structure to ensure you monitor process and outcome variables. The identification limb detects at-risk patients. For this, we recommend an aggregate pediatric early warning score (EWS), clear guidance regarding monitoring type and frequency, flagging of diagnostic risk factors, and a mandatory escalation system that uses the expertise of nurses, patients, and families and works around barriers to enhance response team activation. The structure and function of the response limb are also dependent upon the needs of the institution. We recommend a multidisciplinary team with the skills and resources to assess and manage emergencies. Proactive identification through a rover team or scheduled safety huddles may help with earlier identification of at risk patients. The quality improvement and governance structure should be designed around the desired outcomes. Regular monitoring and review of successes, near misses, and failures are vital for the system to improve outcomes.

Original languageEnglish (US)
Pages (from-to)76-89
Number of pages14
JournalCurrent Treatment Options in Pediatrics
Volume1
Issue number1
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

Pediatrics
Quality Improvement
Extremities
Patient Harm
Therapeutics
Critical Care
Heart Arrest
Intensive Care Units
Length of Stay
Patient Care
Emergencies
Nurses
Safety
Mortality

Keywords

  • Calling criteria
  • Critical care outreach team
  • Early Warning
  • Medical emergency team
  • Pediatric
  • Rapid response team

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Pediatric Rapid Response Systems : Identification and Treatment of Deteriorating Children. / Levin, Amanda; Brady, Patrick; Duncan, Heather P.; Davis, Aisha Barber.

In: Current Treatment Options in Pediatrics, Vol. 1, No. 1, 01.03.2015, p. 76-89.

Research output: Contribution to journalReview article

Levin, Amanda ; Brady, Patrick ; Duncan, Heather P. ; Davis, Aisha Barber. / Pediatric Rapid Response Systems : Identification and Treatment of Deteriorating Children. In: Current Treatment Options in Pediatrics. 2015 ; Vol. 1, No. 1. pp. 76-89.
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