Rapid Response Systems Across Multisite Locations of a Pediatric Hospital System: Patient Characteristics Matter Most.

Abstract

Rapid response systems (RRSs) have become a common presence in hospitals globally since their first formal description by Lee et al1 in 1995. Given the success of these teams at improving pediatric outcomes, rapid response team implementation in pediatric institutions has an established foothold as well, spreading from tertiary hospitals to affiliated satellite institutions and community hospitals. The gap in knowledge now is how patient outcomes may vary across these settings and what features of RRSs and escalation systems need adaptation or are not relevant. In the article by Bavare et al,2 the authors have designed a multisite single institution retrospective observational study to evaluate patient characteristics, outcomes, and use differences between sites with similar RRSs. The strength of this study is the relatively consistent framework and policies implemented from an institutional level at sites where patient characteristics, staffing experience, subspecialist availability, and other contextual factors vary significantly. The authors present the principles of a “realist evaluation” to consider the effects of local context and social structure on program performance.3 A total of 2935 rapid response team activations were evaluated across 3 medical campuses (1816 at the central campus and 405 at 2 satellite campuses). As would be expected, there was a larger proportion of medically complex patients at the central campus. Although the central campus and satellite campuses had identical RRS protocols, they had variations in …