Rapid Response Teams Can Save Hospitalized Kids

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The current study was a before-and-after look at mortality and cardiorespiratory arrest rates at Lucile Packard Children's Hospital in Palo Alto, Calif.

After rapid response teams were added at the hospital on Sept. 1, 2005, the monthly death rate decreased by 18 percent, while the rate of cardiopulmonary arrests (what doctors call "codes") declined by almost 72 percent.

The authors estimated that 33 children's lives were saved over a 19-month period.

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"What was particularly profound was both the codes outside of ICU and mortality rates dropped precipitously within a month of the intervention, which is fairly unusual for a quality-improvement initiative," said Dr. Paul J. Sharek, study lead author, assistant professor of pediatrics at Stanford University School of Medicine in Palo Alto, Calif., and chief clinical patient safety officer at Lucile Packard Children's Hospital. "Usually, it takes three to six months to roll out . . . I would say that this really encourages children's hospitals to really think hard about this being an intervention that truly improves the mortality rate."

Why did this study see improvements in mortality, while the other two did not? One possible reason was that it covered a longer time period. The second, and probably more important reason, was that many of the children studied at Lucile Packard tended to be extremely sick. "The kids are medically so fragile that if you happen to be able to catch their decompensation early, you're more likely to have a great outcome," Sharek said.

But the editorial authors are not completely convinced that rapid response teams, while helpful, are the most efficient answer to the problem.

For one thing, vital signs for adults are pretty much the same regardless of whether the person is 20 years old or 80, making it easier to respond to abnormalities. For children, vitals can vary drastically from a nine-month-old to a 15-year old.

"When you start to take all of the age distributions, the number of trigger points become very large, and as soon as it gets more complicated, it's harder to remember and to implement," Brilli said.

More information

There's more on kids' health at the Nemours Foundation.

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