title: Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children's Hospital.
abstract: BACKGROUND
  Introduction of a rapid response team (RRT) has been shown to decrease mortality and cardiopulmonary arrests outside of the intensive care unit (ICU) in adult inpatients. No published studies to date show significant reductions in mortality or cardiopulmonary arrests in pediatric inpatients.
  
  
  OBJECTIVE
  To determine the effect on hospital-wide mortality rates and code rates outside of the ICU setting after RRT implementation at an academic children's hospital.
  
  
  METHODS
  A cohort study design with historical controls at a 264-bed, free-standing, quaternary care academic children's hospital. Pediatric inpatients who spent at least 1 day on a medical or surgical ward between January 1, 2001, and March 31, 2007, were included. A total of 22,037 patient admissions and 102,537 patient-days were evaluated preintervention (before September 1, 2005), and 7257 patient admissions and 34,420 patient-days were evaluated postintervention (on or after September 1, 2005).
  
  
  METHODS
  The RRT included a pediatric ICU-trained fellow or attending physician, ICU nurse, ICU respiratory therapist, and nursing supervisor. This team was activated using standard criteria and was available at all times to assess, treat, and triage decompensating pediatric inpatients.
  
  
  METHODS
  Hospital-wide mortality rates and code (respiratory and cardiopulmonary arrests) rates outside of the ICU setting. All outcomes were adjusted for case mix index values.
  
  
  RESULTS
  After RRT implementation, the mean monthly mortality rate decreased by 18% (1.01 to 0.83 deaths per 100 discharges; 95% confidence interval [CI], 5%-30%; P = .007), the mean monthly code rate per 1000 admissions decreased by 71.7% (2.45 to 0.69 codes per 1000 admissions), and the mean monthly code rate per 1000 patient-days decreased by 71.2% (0.52 to 0.15 codes per 1000 patient-days). The estimated code rate per 1000 admissions for the postintervention group was 0.29 times that for the preintervention group (95% likelihood ratio CI, 0.10-0.65; P = .008), and the estimated code rate per 1000 patient-days for the postintervention group was 0.28 times that for the preintervention group (95% likelihood ratio CI, 0.10-0.64; P = .007).
  
  
  CONCLUSIONS
  Implementation of an RRT was associated with a statistically significant reduction in hospital-wide mortality rate and code rate outside of the pediatric ICU setting.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA. psharek@lpch.org
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: Layla M
authors.initials: LM
authors.lastname: Parast
authors.forename: Kit
authors.initials: K
authors.lastname: Leong
authors.forename: Jodi
authors.initials: J
authors.lastname: Coombs
authors.forename: Karla
authors.initials: K
authors.lastname: Earnest
authors.forename: Jill
authors.initials: J
authors.lastname: Sullivan
authors.forename: Lorry R
authors.initials: LR
authors.lastname: Frankel
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010348:Patient Care Team