Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-27T23:51:03.536Z Has data issue: false hasContentIssue false
  • English
  • Français

Improved outcomes after implementation of a specialized pediatric cardiac rapid response team

Published online by Cambridge University Press:  24 February 2021

Angela S. McKeta Open the ORCID record for Angela S. McKeta [Opens in a new window] ,
Anthony M. Hlavacek ,
Shahryar M. Chowdhury Open the ORCID record for Shahryar M. Chowdhury [Opens in a new window] ,
Mark Scheurer ,
Eric M. Graham ,
Sinai C. Zyblewski  and
Jason R. Buckley
Angela S. McKeta*
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Anthony M. Hlavacek
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Shahryar M. Chowdhury
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Mark Scheurer
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Eric M. Graham
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Sinai C. Zyblewski
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Jason R. Buckley
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
*
Author for correspondence: A. S. McKeta, MPAS, PA-C. Department of Pediatrics, Medical University of South Carolina, 10 McClennan Banks Drive, MSC915, Charleston, SC29425, USA. Tel: +1 843 792 5877; Fax: +1 843 792 5878. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The efficacy of a specialized pediatric cardiac rapid response team is unknown. We hypothesized that a specialized cardiac rapid response team would facilitate team-wide communication between the cardiac stepdown unit and cardiac intensive care unit (ICU) teams and improve patient care.

Materials and methods:

A specialized pediatric cardiac rapid response team was implemented in June 2015. All pediatric cardiac rapid response team activations and outcomes from implementation through December 2018 were reviewed. Cardiac arrests and unplanned transfers to the cardiac ICU were indexed to 1000 patient-days to account for inpatient volume trends and evaluated over time.

Results:

There were 202 cardiac rapid response team activations in 108 unique patients during the study period. After implementation of the pediatric cardiac rapid response team, unplanned transfers from the cardiac stepdown unit to the cardiac ICU decreased from 16.8 to 7.1 transfers per 1000 patient days (p = 0.012). The stepdown unit cardiac arrest rate decreased from 1.2 to 0.0 arrests per 1000 patient-days (p = 0.015). There was one death on the cardiac stepdown unit in the 5 years since the implementation of the cardiac rapid response team, compared to four deaths in the previous 5 years.

Conclusions:

A reduction in unplanned cardiac ICU transfers, cardiac arrests, and mortality on the cardiac stepdown unit has been observed since the implementation of a specialized pediatric cardiac rapid response team. A specialized cardiac rapid response team may improve communication and empower the interdisciplinary care team to escalate care for patients experiencing clinical decline.

Keywords

Rapid response teampediatric cardiologycardiac arrest
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1582 - 1588
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McKelvie, B, McNally, JD, Chan, J, Momoli, F, Ramsay, C, Lobos, AT. Increased mortality and length of stay associated with medical emergency team review in hospitalized pediatric patients: a retrospective cohort study. Pediatr Crit Care Med 2017; 18: 571–579.10.1097/PCC.0000000000001164CrossRefGoogle ScholarPubMed
Raymond, TT, Bonafide, CP, Praestgaard, A, et al. American heart association get with the guidelines-resuscitation investigators. Pediatric medical emergency team events and outcomes: a report of 3647 events from the American heart association’s get with the guidelines registry. Hosp Pediatr 2016; 6: 57–64.CrossRefGoogle Scholar
Chen, JG, Kemper, AR, Odetola, F, Cheifetz, IM, Turner, DA. Prevalence, characteristics, and opinions of pediatric rapid response teams in the United States. Hosp Pediatr 2012; 2: 133–140.CrossRefGoogle ScholarPubMed
Bonafide, CP, Localio, AR, Roberts, KE, Nadkarni, VM, Weirich, CM, Keren, R. Impact of rapid response system implementation on critical deterioration events in children. JAMA Pediatr 2014; 168: 25–33.CrossRefGoogle ScholarPubMed
Sandquist, M, Tegtmeyer, K. No more pediatric code blues on the floor: evolution of pediatric rapid response teams and situational awareness plans. Transl Pediatr 2018; 7: 291–298.CrossRefGoogle ScholarPubMed
Holmberg, MJ, Wiberg, S, Ross, CE, et al. Trends in survival after pediatric in-hospital cardiac arrest in the United States. Circulation 2019; 140: 1398–1408.10.1161/CIRCULATIONAHA.119.041667CrossRefGoogle ScholarPubMed
Rhodes, JF, Blaufox, AD, Seiden, HS, et al. Cardiac arrest in infants after congenital heart surgery. Circulation 1999; 100 (Suppl 2): 194–199.CrossRefGoogle ScholarPubMed
Orrtman, L, Prodhan, P, Gossett, J, et al. American Heart association get with the guidelines-resuscitation investigators. Outcomes after in-hospital cardiac arrest in children with cardiac disease. Circulation 2011; 124: 2329–2237.CrossRefGoogle Scholar
Bavare, AC, Rafie, KS, Bastero, PX, Hagan, JL, Checchia, PA. Acute decompensation in pediatric cardiac patients: outcomes after rapid response events. Pediatr Crit Care Med 2017; 18: 414–419.10.1097/PCC.0000000000001117CrossRefGoogle ScholarPubMed
Burstein, DS, Jacobs, JP, Li, JS, et al. Care models and associated outcomes in congenital heart surgery. Pediatrics 2011; 127: 1482–1489.10.1542/peds.2010-2796CrossRefGoogle ScholarPubMed
Burstein, DS, Rossi, AF, Jacobs, JP, et al. Variation in models of care delivery for children undergoing congenital heart surgery in the United States. World J Pediatr Congenit Heart Surg 2010; 1: 8–14.CrossRefGoogle ScholarPubMed
Kipps, AK, Cassidy, SC, Strohacker, CM, et al. Collective quality improvement in the paediatric cardiology acute care unit: establishment of the pediatric acute care cardiology collaberative (PAC3). Cardiol Young 2018; 28: 1019–1023.CrossRefGoogle Scholar
Ladner, TR, Mahdi, J, Gindville, MC, et al. Pediatric acute stroke protocol activation in a children’s hospital emergency department. Stroke 2015; 46: 2328–2331.10.1161/STROKEAHA.115.009961CrossRefGoogle Scholar
Dalesio, NM, Diaz-Rodriguez, N, Koka, R, et al. Development of a multidisciplinary airway program: an institutional experience. Hosp Pediatr 2019; 9: 468–475.CrossRefGoogle Scholar
McLellan, MC, Connor, JA. The cardiac children’s hospital early warning score (C-CHEWS). J Pediatr Nurs 2013; 28: 171–178.CrossRefGoogle Scholar
Gaies, M, Cooper, DS, Tabbut, S, et al. Collaborative quality improvement in the cardiac intensive care unit: development of the pediatric cardiac critical care consortium (PC4). Cardiol Young 2015; 25: 951–957.10.1017/S1047951114001450CrossRefGoogle Scholar
Institute for Healthcare Improvement Run Chart Tool, 2020. http://www.ihi.org/resources/Pages/Tools/RunChart.aspx.Google Scholar
Newburger, JW, Wypig, D, Bellinger, DC, et al. Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr 2003; 143: 67–73.CrossRefGoogle ScholarPubMed
Andersen, LW, Berg, KM, Saindon, BZ, et al. Time to epinephrine and survival after pediatric in-hospital cardiac arrest. JAMA 2015; 314: 802–810.CrossRefGoogle ScholarPubMed
Marino, BS, Tabbut, S, MacLaren, G, et al. Cardiopulmonary resuscitation in infants and children with cardiac disease. Circulation 2018; 137: e691–e792.CrossRefGoogle ScholarPubMed
Tibballs, J, Kinney, S, Duke, T, Oakley, E, Hennessy, M. Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child 2005; 90: 1148–1152.CrossRefGoogle ScholarPubMed
Brilli, RJ, Gibson, R, Luria, JW, et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med 2007; 8: 236–426.CrossRefGoogle Scholar
Kotsakis, A, Lobos, AT, Parshuram, C, et al. Implementation of a multicenter rapid response system in pediatric academic hospitals is effective. Pediatrics 2011; 128: 72–78.CrossRefGoogle ScholarPubMed
Kronick, SL, Kurz, MC, Lin, S, et al. Part 4: systems of care and continuous quality improvement: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132 (Suppl 2): S397–S413.10.1161/CIR.0000000000000258CrossRefGoogle ScholarPubMed
Society for Thoracic Surgeons Public Reporting, 2021. https://publicreporting.sts.org/congenital/1073605879.Google Scholar