title: Development of a pragmatic measure for evaluating and optimizing rapid response systems.
abstract: OBJECTIVE
  Standard metrics for evaluating rapid response systems (RRSs) include cardiac and respiratory arrest rates. These events are rare in children; therefore, years of data are needed to evaluate the impact of RRSs with sufficient statistical power. We aimed to develop a valid, pragmatic measure for evaluating and optimizing RRSs over shorter periods of time.
  
  
  METHODS
  We reviewed 724 medical emergency team and 56 code-blue team activations in a children's hospital between February 2010 and February 2011. We defined events resulting in ICU transfer and noninvasive ventilation, intubation, or vasopressor infusion within 12 hours as "critical deterioration." By using in-hospital mortality as the gold standard, we evaluated the test characteristics and validity of this proximate outcome metric compared with a national benchmark for cardiac and respiratory arrest rates, the Child Health Corporation of America Codes Outside the ICU Whole System Measure.
  
  
  RESULTS
  Critical deterioration (1.52 per 1000 non-ICU patient-days) was more than eightfold more common than the Child Health Corporation of America measure of cardiac and respiratory arrests (0.18 per 1000 non-ICU patient-days) and was associated with >13-fold increased risk of in-hospital death. The critical deterioration metric demonstrated both criterion and construct validity.
  
  
  CONCLUSIONS
  The critical deterioration rate is a valid, pragmatic proximate outcome associated with in-hospital mortality. It has great potential for complementing existing patient safety measures for evaluating RRS performance.
authors.affiliation: Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. bonafide@email.chop.edu
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Bonafide
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Roberts
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Priestley
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Tibbetts
authors.forename: Emily
authors.initials: E
authors.lastname: Huang
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D057209:Hospital Rapid Response Team / Q000592:standards*; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology