Abstract
Our hospital is one of the largest pediatric facilities in Japan, with 490 beds, 20 beds in the pediatric intensive care unit (PICU), and approximately 7000 annual inpatients. Our hospital has used the rapid response system (RRS) since its introduction in February 2011. To investigate the benefits and challenges of the RSS, we compared RRS-related items during the 2-year period before with the 2-year period after the introduction of the RRS. The RRS was used for a mean of 74 times per month and 117 times per 1,000 hospitalizations. No improvement was observed in the number of inpatient deaths (before vs. after introduction: 1.7 vs. 2.0/1,000 hospitalizations; p = 0.42), unexpected in-hospital cardiac arrests (0.4 vs. 0.5/1000 hospitalizations; p = 0.94), or code blue calls (0.7 vs. 0.9/1,000 hospitalizations; p = 0.61). However, a significant improvement was observed in the number of PICU deaths (23.4 vs. 12.6/1000 hospitalizations; p < 0.01). In addition, a tendency, although nonsignificant, toward improvement was observed in the number of deaths in patients unexpectedly admitted to the PICU owing to in-hospital acute deterioration (70.9 vs. 41.4/1,000 hospitalizations; p = 0.42). RRS use varied between the wards. The RRS use rate for PICU cases with in-hospital acute deterioration was low (40.7%); for the other cases, only the primary department was called. Furthermore, the clinical characteristics of cases in which the RRS was difficult to apply included convulsions, decreased consciousness level, and upper airway stenosis. This study showed an insufficient utilization of the RRS, which limited the effect of its introduction. To improve pediatric outcomes with RRS use, compliance with RRS criteria, improvement in the use rate, criteria review, and post-revision evaluations are required.
