Rapid Response Teams Can Save Hospitalized Kids

Rapid Response Teams Can Save Hospitalized Kids
TUESDAY, Nov. 20 (HealthDay News) -- Incorporating a rapidresponse team of experts at a children's hospital can cut rates of patientdeaths, heart attacks and respiratory arrests outside the intensive careunit, a new study suggests.
"This is the first paper to show an improvement in mortality, so thatadds to the potential that having rapid response teams can really changethe outcome," said Dr. Richard Brilli, author of an editorial thataccompanies the article in the Nov. 21 issue of the Journal of theAmerican Medical Association.
"This validates with research that this is a good process. It's sound,reliable and shows an improvement in outcomes," added Audrey Hubbard,director of children's services at The Children's Hospital at Scott &White in Temple, Texas.
A rapid response team (RRT) is composed of experts from differentdisciplines who are available 24-7 to evaluate patients who arehospitalized but not in the intensive care unit (ICU). The experts arefrequently trained in ICU procedures.
Such teams have been extensively studied and have been shown todecrease mortality and cardiopulmonary arrest rates in hospitalizedadults. The research in children is more limited.
"In pediatrics, there have only been three papers [including thecurrent one], and that's not a very robust literature yet to say this isright or wrong," Brilli said.
Two of those papers (one led by Brilli) showed a benefit incardiopulmonary arrest rates without a benefit in mortality.
There is a clear need for some kind of intervention, however.
"[There are] children who have deterioration while in the hospital, somuch so that they end up having a cardiopulmonary arrest," Brilli said."The question is what is the best method to recognize that patient who isgetting sicker and do something about it before they get so sick?"
The current study was a before-and-after look at mortality andcardiorespiratory arrest rates at Lucile Packard Children's Hospital inPalo Alto, Calif.
After rapid response teams were added at the hospital on Sept. 1, 2005,the monthly death rate decreased by 18 percent, while the rate ofcardiopulmonary arrests (what doctors call "codes") declined by almost 72percent.
The authors estimated that 33 children's lives were saved over a19-month period.
"What was particularly profound was both the codes outside of ICU andmortality rates dropped precipitously within a month of the intervention,which is fairly unusual for a quality-improvement initiative," said Dr.Paul J. Sharek, study lead author, assistant professor of pediatrics atStanford University School of Medicine in Palo Alto, Calif., and chiefclinical patient safety officer at Lucile Packard Children's Hospital."Usually, it takes three to six months to roll out . . . I would say thatthis really encourages children's hospitals to really think hard aboutthis being an intervention that truly improves the mortality rate."
Why did this study see improvements in mortality, while the other twodid not? One possible reason was that it covered a longer time period. Thesecond, and probably more important reason, was that many of the childrenstudied at Lucile Packard tended to be extremely sick. "The kids aremedically so fragile that if you happen to be able to catch theirdecompensation early, you're more likely to have a great outcome," Shareksaid.
But the editorial authors are not completely convinced that rapidresponse teams, while helpful, are the most efficient answer to theproblem.
For one thing, vital signs for adults are pretty much the sameregardless of whether the person is 20 years old or 80, making it easierto respond to abnormalities. For children, vitals can vary drasticallyfrom a nine-month-old to a 15-year old.
"When you start to take all of the age distributions, the number oftrigger points become very large, and as soon as it gets more complicated,it's harder to remember and to implement," Brilli said.
More information
There's more on kids' health at the Nemours Foundation.