Characteristics and outcomes of pediatric rapid response teams before and after mandatory triggering by an elevated Pediatric Early Warning System (PEWS) score.
BACKGROUND
The Pediatric Early Warning System (PEWS) was created to identify unstable patients before their deterioration. Rapid response teams (RRTs) were developed to assist with management of such patients. In 2009, our institution mandated the activation of RRTs if a PEWS score was elevated (ie, ≥5).


OBJECTIVE
The goal of this study was to examine changes in characteristics of RRT calls before and after the implementation of a mandatory hospital policy requiring RRT activation due to an elevated PEWS score.


METHODS
This study was a retrospective database review, with RRT data from June 2007 to December 2010 examined. A total of 44 RRTs were recorded before mandatory triggering and 69 RRTs afterward in the study period (P = .32).


RESULTS
Compared with the premandatory group, the mandatory triggering group found that tachycardia was a more frequent trigger for RRTs, with an increase of 26.1% (P = .004). RRTs triggered by a change in mental status/agitation decreased by 22.9% (P = .009). An increase of 15.1% of RRTs required no interventions with mandatory triggering. Nighttime RRTs increased by17.5% (P = .07). There was a trend toward decreased PICU transfers in the mandatory triggering group, with no significant change in code blue calls.


CONCLUSIONS
A hospital policy of mandating RRT activation based on PEWS scores increased nighttime calls and altered the primary reasons for RRT activation in our center, with no evidence of improvements in patient care. These findings should be interpreted with caution given the relatively rare outcomes the policy is intended to prevent; however, our findings highlight the difficulties inherent in evaluating methods to improve pediatric patient safety.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stony Brook Long Island Children's Hospital, Stony Brook, New York.
Rahul
R
Panesar
Lee A
LA
Polikoff
David
D
Harris
Barbara
B
Mills
Catherine
C
Messina
Margaret M
MM
Parker
D002648:Child; D006305:Health Status Indicators; D057209:Hospital Rapid Response Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D037141:Mandatory Programs; D017146:Models, Organizational; D016134:Organizational Policy; D010372:Pediatrics / Q000458:organization & administration / Q000592:standards; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013610:Tachycardia
early warning system; pediatric; rapid response team