Developing a rapid response team is one of the six recommended interventions in the Institute for Healthcare Improvement’s 100,000 Lives Campaign. UNC Hospitals has been a part of this national campaign since it began last year.
A small number of medical centers, believed to be less than 20 nationwide, have created rapid response teams for their pediatric patients. Last August, the N.C. Children’s Hospital at UNC Hospitals became the first in North Carolina to activate its Pediatric Rapid Response Team.
To date, UNC's Pediatric Rapid Response Team is the only such team operating in the Triangle region. Statewide, only one other pediatric rapid response team is currently up and running.
The team is composed of the Pediatric Intensive Care Unit (PICU) Fellow MD Team Leader, PICU Charge Nurse, PICU Respiratory Therapist, Senior Pediatric Resident, and the patient’s primary team. The team is available 24 hours per day, seven days per week.
There are some key differences between the guidelines for triggering the traditional Code Blue and Pediatric Rapid Response Teams into action. In general, a Code Blue is called only after a patient is in cardiopulmonary arrest. In contrast, the N.C. Children’s Hospital staff has been encouraged to call the Pediatric Rapid Response Team for any of the following reasons:
* Staff or a family member is worried about the patient — a “gut feeling” is more than enough.
* There are acute changes in the patient’s heart rate, blood pressure, respiratory rate or oxygen saturation.
* The patient's mental status changes.
* There is a new or prolonged seizure.
* The patient has a difficult time controlling pain or agitation.
The team has been a trigger for a cultural change throughout our entire system. With this new system, there are no false alarms and the caller is always treated with respect and not scolded for calling the team. This new process has improved communication and teamwork between the ICU and the non-ICU areas of the hospital.
The new system also helps us collect information related to these calls as well as for cardiac and respiratory arrests. Through this new system we have also identified several patterns that highlight possible system safety issues that have been addressed to improve hospital-wide safety. Without the systemized activation system and data collection, these safety issues may not have been discovered.
Although the team has only been in place for six months, we have received 32 activations of the team thus far. The team has responded to the patient in less than five minutes every time.
Understanding that we have much to teach one another in the hospital community, the Institute for Healthcare Improvement has developed a list of “mentor hospitals” that others can turn to for advice. UNC has been named a mentor hospital for our work on our Pediatric Rapid Response Team, and we are available to physicians and hospitals around the country looking for insights or advice on developing and maintaining such a program.
This is one more example of UNC leading the way.