Stanford Medicine Newsletter Updates For the Local Community

Saving the lives of children through early intervention

Spring 2008

Play eases the anxiety of Bernard Dannenberg's young patient.

Packard's Rapid Response Teams provide bedside care before a child's condition becomes life-threatening.

Call it intuition or gut feeling. Whatever you call it, pay attention. That’s the conclusion of researchers at Lucile Packard Children’s Hospital who found that deploying the hospital’s Rapid Response Teams at the first inkling of trouble—rather than taking the standard course of cautiously watching and waiting—can significantly reduce mortality in hospitalized children.

Packard implemented the Rapid Response Teams in 2005 to reduce the frequency of emergency codes of children who are hospitalized but outside the intensive care unit (ICU). A code occurs when a child’s heart or breathing stops. Many young patients in non-ICU settings are very ill and can worsen rapidly.

“The average level of illness at Packard is substantially higher than at the vast majority of other children’s hospitals in North America,” said Paul Sharek, MD, chief clinical patient safety officer at Packard Children’s Hospital. “Although the average child in our medical or surgical hospital units may not require the high nurse-to-patient ratio of the intensive care unit, he or she is still frequently quite ill.”

Rapid Response Teams are trained to provide supportive care in response to subtle warning signs before a child’s condition becomes life threatening. They are present at the hospital around the clock, and they arrive at a child’s bedside anywhere in the hospital within five minutes after a summons to assess a condition. Interventions include providing additional respiratory support, administering additional or different intravenous fluids or transferring the child to the ICU for ongoing monitoring and more intensive therapy.

The researchers found that although many Rapid Response Team calls were triggered by measurable changes in a patient’s status—a change in breathing pattern, blood oxygen content or blood pressure—some calls occurred simply because the child’s medical caregiver or parent felt that something just wasn’t right.

“Even in the hospital, sick children can deteriorate so quickly,” said Sharek. “They don’t have the energy reserves or muscle mass that most adult patients have.”

Sharek estimated that 33 lives—equivalent to an 18 percent reduction in the monthly mortality rate—were saved during the 19-month study period. Although Rapid Response Teams have been shown to be effective in adult care institutions, the Packard study is the first to demonstrate that they result in lower mortality rates in a pediatric setting.

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