Development of a Pragmatic Measure for Evaluating and Optimizing Rapid Response Systems

作者：Bonafide Christopher P^*; Roberts Kathryn E; Priestley Margaret A; Tibbetts Kathleen M; Huang Emily; Nadkarni Vinay M; Keren Ron

来源：Pediatrics, 2012, 129(4): E874-E881.

DOI：10.1542/peds.2011-2784

• child
• critical illness
• early warning score
• hospital rapid response team
• medical emergency team
• physiologic monitoring
• mortality

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. Pediatrics 2012;129:e874-e881

• 出版日期2012-4