P0449 - Adult Rapid Response Events in a Children’s Hospital

Background: Rapid response teams (RRTs) are recommended by the Institute for Healthcare Improvement as a strategy to reduce preventable inpatient deaths. While the primary intent of pediatric RRTs is to intervene when clinical deterioration in an inpatient is first identified, RRTs may also respond to medical emergencies (ME) throughout the hospital. Thus, in a free-standing children’s hospital (FSCH), the RRT may be required to provide the initial care for an adult experiencing a ME. The RRT, however, includes pediatric residents who traditionally are not trained in adult medicine. Few studies investigate whether the RRT at a FSCH is adequately prepared to manage adult ME.

Objective: Describe the demographics, interventions and outcomes for adult rapid response events (RRE) at a FSCH.

Methods: Retrospective chart review of RRE occurring at a FSCH between 2011 and 2018. Patients ≥ 18 years of age were included. The RRT (comprised of a pediatric resident, a registered nurse and a respiratory therapist) responds to all ME occurring outside of the critical care setting. Following initial evaluation, the RRT may escalate the RRE to a “code blue” when impending cardiovascular compromise is identified. Interventions performed were segregated into non-critical (e.g. laboratory studies) and critical (e.g. intubation). Descriptive statistics were performed.

Results: 342 patients were included in the analyses: 226 (66%) RRE and 116 (34%) RRE escalated to a “code blue”. The number of RRE increased from 23 in 2011 to 55 in 2018. The majority of RRE occurred on the inpatient floor (Figure 1). Patients were African American (55%) females (68%) with a mean age of 36.5 years. Most patients (81%) were new adult patients whereas 19% had an established relationship with a pediatric subspecialist at the FSCH. The most common chief complaint was syncope (33%) (Figure 2). Non-critical (74%) interventions were most common. After initial evaluation and stabilization, 236 (69%) were transferred to an adult hospital whereas 42 (12%) were admitted to the FSCH and 48 (14%) were discharged home.

Conclusions: Pediatric residents participating in RRTs provide the initial acute stabilization for adult ME, and the burden of care is increasing over time. Training in the management of common adult ME is not currently part of pediatric residency education; thus, institutional quality improvement initiatives should be developed to provide targeted educational opportunities.