title: Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital.
abstract: BACKGROUND
  Variability in disposition of children according to the time of rapid response calls is unknown.
  
  
  OBJECTIVE
  To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care.
  
  
  METHODS
  Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit.
  
  
  RESULTS
  Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P < .001) than among other intensive care patients (1.4%).
  
  
  CONCLUSIONS
  Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.
authors.affiliation: Stacey Humphreys is a pediatric intensivist, Division of Critical Care Medicine, Palmetto Health Children's Hospital, Columbia, South Carolina. Balagangadhar R. Totapally is medical director of the pediatric intensive care unit, Division of Critical Care Medicine, Miami Children's Hospital, and a clinical professor of pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Stacey
authors.initials: S
authors.lastname: Humphreys
authors.affiliation: Stacey Humphreys is a pediatric intensivist, Division of Critical Care Medicine, Palmetto Health Children's Hospital, Columbia, South Carolina. Balagangadhar R. Totapally is medical director of the pediatric intensive care unit, Division of Critical Care Medicine, Miami Children's Hospital, and a clinical professor of pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. bala.totapally@mch.com.
authors.forename: Balagangadhar R
authors.initials: BR
authors.lastname: Totapally
mesh_terms: D002648:Child; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors