PURPOSE: Out-of-ICU arrest is a significant cause of in-hospital morbidity/mortality. Rapid response teams (RRT's) decrease out-of-ICU arrests but pediatric data are limited. We implemented a unique, nurse-directed RRT in Oct 2005 wherein the primary responder is the ICU charge nurse who involves physicians at her discretion. We hypothesized that this design would also decrease out-of-ICU arrests and be viewed as more accessible by floor caregivers.
METHODS: This retrospective review was approved by the IRB of the University of Louisville. Records of RRT calls, including requestor-completed satisfaction surveys, were reviewed. Specific information collected included reason for request, responder type, interventions performed, patient disposition and requestor satisfaction. Arrest frequencies pre- and post-implementation were compared.
RESULTS: Following implementation, out-of-ICU arrests decreased from 0.18/1000 hospital days (HD; 22 months) to 0.02/1000 HD (41 months; RR 0.14, p=0.002), including a 31 month stretch during which there were zero arrests! The PICU arrest rate did not increase post-implementation (3.87 vs 3.11/1000 HD, p=0.28). 162 consecutive calls were evaluated, equally distributed between day and night shift. Primary reasons for calls were respiratory (n=96), neurologic (n=30) and/or CV instability (n=24). An MD accompanied the RN on only 44 calls (27.2%). 70 patients (43.2%) were transferred to the PICU. Evaluations were received for 106 patients and indicated high satisfaction with the RRT in 102. 3 requested improved education by responders. Modest initial house officer discomfort with the RRT has resolved with resident education.
CONCLUSION: In a tertiary care Children's Hospital, implementation of a nurse-directed RRT was associated with a marked decrease in out-of-ICU arrests. That the PICU arrest rate was unchanged suggests that the RRT did not simply transfer impending arrests to the PICU. The team was well received and initiators stated no hesitancy in activating it.
CLINICAL IMPLICATIONS: In institutions, especially where 24/7 ICU physician availability may be limited, an ICU nurse-directed RRT can offer a viable, acceptable, and effective resource to general wards for both patient assessment/intervention and caregiver education.
DISCLOSURE: John Berkenbosch, No Financial Disclosure Information; No Product/Research Disclosure Information