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Abstract

Introduction: Rapid response teams (RRTs) have become standard in American pediatric hospitals, but there is little guidance about their optimal structure and function. Hypothesis: We gathered data characterizing the standard of care across the country to identify factors that correlate with a reduced arrest rate. We hypothesized that an increased RRT dose (# RRTs/# hospital beds) and larger hospital size would correlate with a lower arrest rate. Methods: 62 question telephone survey, including a description of arrest and rapid response team composition and function, and number of events for 2011. Results: We collected data from 30 top American pediatric hospitals, all of which provide ECMO support, have a PICU fellowship, and 24 hour RRTs. A PICU doctor is part of 93% of arrest teams and 73% of RRTs. Of the 17 hospitals with only 1 PICU doctor (fellow or attending) in house overnight, 59% have the single PICU doctor on the RRT. 77% of institutions receive no additional staffing or financial support to run the RRT. 77% of responders have a family activated RRT program, but only 60% report having any family activated calls in 2011. 90% of institutions list “Respiratory” as the reason for most RRT calls. 55% of RRT calls result in a patient transfer to the PICU. The definition for “code event” varies drastically between hospitals, including hospitals belonging to the Children’s Health Corporation of America, which has provided a standard definition for codes outside the ICU. Only 60% of responders thought the presence of RRTs had decreased the number of non-ICU chest compressions or emergent intubations. For the 27 hospitals who tracked this data, the median number of RRT calls in 2011 was 130 (range 11 to 664). We found no correlation between RRT dose and arrest rate (r = 0.04). We found a weak correlation showing a decreased arrest rate in the hospitals with more total beds (r = 0.3). Conclusions: This study demonstrates the wide variability in RRT practice in American pediatric hospitals. Although larger hospitals show a weak correlation with lower arrest rates, RRT variability makes it difficult to identify which RRT characteristics are most important in realizing the ultimate goal of preventing floor arrests.