Experience of pediatric rapid response team in a tertiary care hospital in Pakistan.
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).


CONCLUSIONS
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.
Anwar-ul-Haque
Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan. anwar.haq@aku.edu
Saleem
Ali Faisal
AF
Zaidi
Samreen
S
Haider
Syed Rizwan
SR
D002675:Child, Preschool; D054869:Clinical Audit; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010154:Pakistan; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies