O0439 Oct.5: 4:01pm - Rapid Response Event Triggers and Outcomes in Children; Do Multiple Triggers Lead to Worse Outcomes?

Background/Purpose:
Rapid response teams (RRT) aim to identify deteriorating hospitalized patients receiving care outside the intensive care unit. The goal of deploying these teams is to quickly and efficiently respond to triggers that indicate worsening prognosis or rapid deterioration of clinical status in order to determine whether a patient would benefit from transfer to a higher level of care. As rapid response teams are refined and developed, it is important to consider the triggers that result in worse prognosis. The purpose of this study is to determine if multiple rapid response triggers lead to worse patient outcomes in the review of data from a large tertiary pediatric hospital.

Methods:
Patient and RRT characteristics and outcomes are summarized using mean with standard deviation, median with 25th and 75th percentiles, and frequency with percentage. Characteristics and outcomes are compared by triggers using quantile regression, Chi-square test and Fisher's exact test. All analyses are performed using Stata v 15.

Results:
There were a total of 2275 RRTs from 2096 patients. RRT events with multiple triggers were associated with longer ICU length of stay, increased incidence of code alarm events, and higher frequencies of transfer to higher level of care.

Conclusion:
There are various iterations of rapid response teams. Identification of at risk patients often involves the determination of triggers that will alert the rapid response team. These systems are often most effective when predetermined goals of care and health system strengths inform the rapid response infrastructure. Identification of at risk patients often includes the use of aggregate pediatric early warning scores, the use of frequently monitored vital signs, flagging of diagnostic risk factors, as well as physician and parental concern regarding clinical status. It becomes important to determine the frequency and method of monitoring for these data points to determine the probability that a trigger to the rapid response team is timely and employs the appropriate hospital resources and staff. We have identified that multiple triggers can lead to increased intensive care length of stay, increased frequency of codes in pediatric patients, and need for a higher level of care. Regular review of successes and failures of the rapid response team deployment can inform a more targeted use of the system and inform future triggers.