(822) Characterizing Rapid Response Team Activations and Contributing Factors

Introduction: Rapid Response Teams (RRTs) were recommended by the Institute of Medicine as a way to respond to deterioration on the floor. Over time, our goal for RRTs became to prevent cardiac arrest or significant deterioration outside of the pediatric intensive care unit (PICU) by facilitating warranted transfers or intervening to mitigate deterioration. RRTs require time & resources from both floor & ICU teams. When multiple teams are involved, assessments, including decision to transfer, can be discordant. Improving alignment of assessments to reduce discord & potentially prevent unnecessary RRTs requires understanding the causes & factors surrounding them.

Methods: We retrospectively examined a database of all RRTs from a single unit with multiple medical teams at a large quaternary academic pediatric medical center from 2019-2024. Demographics, RRT indication, event details and floor staff comments were abstracted with charts reviewed for clinical course. Frequency & trends were evaluated using descriptive statistics. Staff comments were reviewed & categorized if differences in assessments, communication concerns, or unclear treatment plans contributed to the RRT.

Results: A total of 434 RRTs were abstracted. Principle RRT indications included concerns for seizure (28%), respiratory decompensation (22%), altered mental status (16%), & shock (15%). Sixty-four (15%) had ≥1 prior RRT in the preceding 48 hours. Plan confusion, differences in clinical assessment, and/or suboptimal communication contributed to 53 (12%) RRT initiations. Communication concerns were most frequently identified (27/53, 51%). 27 (51%) transferred to an ICU. In 16 (4%) RRTs, communication & differences in assessment between floor and ICU teams remained after RRT. 8/16 (50%) transferred to an ICU.

Conclusions: RRT indications were primarily worsening status of unit-specific pathology or cardio/pulmonary compromise. For a clinically significant subset, unclear plans, differing assessments, & gaps in communication contributed to RRT. For a small group, notable discordance between ICU and floor teams remained after the RRT. Interventions targeting interdisciplinary communication skills & contingency planning for frontline providers may decrease conflict surrounding RRTs, improve patient care and potentially decrease unnecessary RRTs.