title: Implementation of a multicenter rapid response system in pediatric academic hospitals is effective.
abstract: OBJECTIVE
  This is the first large multicenter study to examine the effectiveness of a pediatric rapid response system (PRRS). The primary objective was to determine the effect of a PRRS using a physician-led team on the rate of actual cardiopulmonary arrests, defined as an event requiring chest compressions, epinephrine, or positive pressure ventilation. The secondary objectives were to determine the effect of PRRSs on the rate of PICU readmission within 48 hours of discharge and PICU mortality after readmission and urgent PICU admission.
  
  
  METHODS
  A PRRS was developed, implemented, and evaluated in a standardized manner across 4 pediatric academic centers in Ontario, Canada. The team responded to activations for inpatients and followed patients discharged from the PICU for 48 hours. A 2-year, prospective, observational study was conducted after implementation, and outcomes were compared with data collected 2 years before implementation.
  
  
  RESULTS
  After PRRS implementation, there were 55 963 hospital admissions and a team activation rate of 44 per 1000 hospital admissions. There were 7302 patients followed after PICU discharge. Implementation of the PRRS was not associated with a reduction in the rate of actual cardiopulmonary arrests (1.9 vs 1.8 per 1000 hospital admissions; P=.68) or PICU mortality after urgent admission (1.3 vs 1.1 per 1000 hospital admissions; P=.25). There was a reduction in the PICU mortality rate after readmission (0.3 vs 0.1 death per 1000 hospital admissions; P=.05).
  
  
  CONCLUSIONS
  The standardized implementation of a multicenter PRRS was associated with a decrease in the rate of PICU mortality after readmission but not actual cardiopulmonary arrests.
authors.affiliation: FRCP(C), Hospital for Sick Children, Department of Critical Care Medicine, 555 University Ave Toronto, Ontario, Canada M5G 1X8. afrothite.kotsakis@sickkids.ca
authors.forename: Afrothite
authors.initials: A
authors.lastname: Kotsakis
authors.forename: Anna-Theresa
authors.initials: AT
authors.lastname: Lobos
authors.forename: Christopher
authors.initials: C
authors.lastname: Parshuram
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gilleland
authors.forename: Rose
authors.initials: R
authors.lastname: Gaiteiro
authors.forename: Hadi
authors.initials: H
authors.lastname: Mohseni-Bod
authors.forename: Ram
authors.initials: R
authors.lastname: Singh
authors.forename: Desmond
authors.initials: D
authors.lastname: Bohn
mesh_terms: D002648:Child; D002675:Child, Preschool; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies