Development of a pragmatic measure for evaluating and optimizing rapid response systems

Pediatrics. 2012 Apr;129(4):e874-81. doi: 10.1542/peds.2011-2784. Epub 2012 Mar 5.


Objectives: 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.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Cardiopulmonary Resuscitation / trends*
  • Child
  • Child, Preschool
  • Female
  • Heart Arrest / mortality
  • Heart Arrest / therapy*
  • Hospital Mortality / trends
  • Hospital Rapid Response Team / standards*
  • Hospitals, Pediatric / organization & administration*
  • Humans
  • Infant
  • Intensive Care Units, Pediatric / organization & administration*
  • Male
  • Monitoring, Physiologic / standards*
  • Reproducibility of Results
  • Retrospective Studies
  • United States / epidemiology