Reducing Cardiopulmonary Arrests and Intensive Care Transfers Using

Disclosures • None of the authors have any documented financial relationships to disclose or

Background • IHI’s 100, 000 Lives Campaign – Develop RRT’s • What is their

Objective • To describe the impact of a pediatric rapid response team on: –

Methods • Pre- & Post-intervention study – June 2009 -September 2010 (pre-intervention) – October

Methods Data Collected Data Calculated • Number of PRRT calls transferred to PICU •

Methods • Statistics – Poisson regression for comparison of the rate differences – 95

Results Pre. Post. Rate Intervention p-value Difference (16 months) (10 Months) Total Calls to

PRRT utilization 106% increase in utilization; (p=0. 0001)

PRRT calls transferred to the PICU Reduced PICU transfers by 28%, (p<0. 001)

Correlation between PRRT call volume and percentage of calls resulting in PICU transfer y

Conclusions • PRRT’s decrease both CPA rates and PICU transfers • Increased utilization results

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Reducing Cardiopulmonary Arrests and Intensive Care Transfers Using a Pediatric Rapid Response Team Erich Maul, DO Sarah Heck, MBA Lee Ann Russell, RN, BSN Barbara Latham, RN, MSN

Disclosures • None of the authors have any documented financial relationships to disclose or any Conflicts of Interest (COI) to resolve • None of the authors have documented that this presentation will involve discussion of unapproved or off-label, experimental or investigational use

Background • IHI’s 100, 000 Lives Campaign – Develop RRT’s • What is their impact? – Adults: ? no impact on mortality

Objective • To describe the impact of a pediatric rapid response team on: – rates of inpatient cardiopulmonary arrest – transfers to elevated levels of care.

Methods • Pre- & Post-intervention study – June 2009 -September 2010 (pre-intervention) – October 2010 -July 2011 (post-intervention) • Multidisciplinary root cause analysis performed in October 2010 • Resulted in an enterprise-wide education program

Methods Data Collected Data Calculated • Number of PRRT calls transferred to PICU • Number of CPA’s outside of PICU • Number of monthly admissions from financial data • PRRT calls/1000 admissions • CPA’s/1000 admissions • Percentage of PRRT calls transferred to PICU • Natural logarithmic transformation of the percentage of PRRT calls transferred to the PICU

Methods • Statistics – Poisson regression for comparison of the rate differences – 95 th percentile confidence interval for the rate difference

Results Pre. Post. Rate Intervention p-value Difference (16 months) (10 Months) Total Calls to PRRT Total Admissions CPA outside the PICU PRRT Calls/1000 admissions CPA/1000 Admissions Percentage of PRRT Calls Transferred to PICU 95% CI 52 64 8547 5095 5 1 6. 08 12. 56 6. 48 0. 0001 0. 59 0. 20 0. 39 <0. 0001 0. 22 -0. 56 48. 1 34. 4 13. 7 <0. 0001 3. 28 -9. 68 8. 1 -19. 3

PRRT utilization 106% increase in utilization; (p=0. 0001)

PRRT calls transferred to the PICU Reduced PICU transfers by 28%, (p<0. 001)

Correlation between PRRT call volume and percentage of calls resulting in PICU transfer y = -0. 1307 x + 4. 4593 R 2 = 0. 3111 R = 0. 56

Conclusions • PRRT’s decrease both CPA rates and PICU transfers • Increased utilization results in decreased transfers to the PICU