UNC Hospitals Among First With Pediatric Rapid Response Team

Posted on Jan. 6, 2006

More U.S. hospitals are getting a jump on Code Blue situations – when person’s heart or lungs, or both, stop working – by establishing what are called “rapid response teams.” As these teams develop, they mainly have been attending to adult patients.

A few medical centers, believed to be less than 20 nationwide, also have created rapid response teams for pediatric patients. The N.C. Children’s Hospital at UNC Hospitals recently became the first in North Carolina to activate its pediatric rapid response team.

“These teams are often very difficult to implement since they require a change in the culture of the hospital,” said Dr. Tina Schade Willis, a pediatric intensivist at the N.C. Children’s Hospital. Willis led the development of UNC’s pediatric rapid response team with Dr. Celeste Mayer, patient safety officer for UNC Hospitals. “But here everyone from the leadership of UNC Hospitals and the N.C. Children’s Hospital to the bedside staff and resident physicians have contributed to the overwhelming acceptance of this life-saving, systemwide intervention.”

Such teams are based on research showing that more lives could be saved if such teams were called into action at the first sign a patient’s condition is deteriorating, which could be several hours earlier than a Code Blue typically would be called. Developing a rapid response team is one of six recommended interventions in the Institute for Healthcare Improvement’s 100,000 Lives Campaign, and the UNC Hospitals have been a part of the campaign since it started last year. An adult rapid response team also has been developed in the UNC Hospitals.

To date, the pediatric rapid response team at the N.C. Children’s Hospital is the only such team operating in the Triangle. Statewide, one other pediatric rapid response team is up and running. At the N.C. Children’s Hospital, the team includes a pediatric critical care physician who serves as team leader, a pediatric critical care nurse and respiratory therapist, a pediatric resident physician as well as the doctors and nurses assigned to the patient.

Any member of the team, or any member of the hospital’s staff, can call it into action. Staff also are instructed to call on behalf of family members. Even if the medical staff does not feel the patient fits criteria for the team to be called, if family members are worried about their child’s condition, the staff is instructed to call the team.

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.)
• Acute changes in the patient’s heart rate, blood pressure, respiratory rate or oxygen saturation.
• Mental status changes.
• A new or prolonged seizure.
• The patient has difficult to control pain or agitation.

The results at the N.C. Children’s Hospital so far have been encouraging. Since Aug. 1, the Pediatric Rapid Response Team has been called into action at least 19 times and there have been no pediatric Code Blue activations for respiratory or cardiac arrest.

“In this new process, there are no false alarms and no negative feedback is to be given to the caller,” Willis said. “The safety of the patient is what’s most important. We are partnering to create a culture where it is easier for medical staff to call for help.”

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