Pediatric Rapid Response Teams

Hospital Name program_pediatric

Johns Hopkins Children’s Center
Baltimore, MD

Program Leader
Elizabeth (Betsy) A. Hunt, MD, MPH

How the Program Came to Be
This committee was created as a sub-committee of the hospital-wide Johns Hopkins CPR Advisory Committee in June 2003. The committee began meeting regularly in October 2003. The person who initiated this program was Dr. Hunt. At the beginning of the process, she was a Pediatric Intensive Care Unit (PICU) Fellow who had taken care of Josie when she was in the PICU. She had also recently completed a Masters in Public Health at the Johns Hopkins School of Public Health, where her thesis project was related to developing systems to identify and correct problems regarding the management of children who have a cardiopulmonary arrest while on the wards of the Johns Hopkins Children’s Hospital. Dr. Hunt believed very strongly that while the medical and nursing staff were clearly dedicated to providing the best possible care to children admitted to the Children’s Hospital, there were systems issues that occasionally allowed children to become critically ill on the wards and not receive optimum care. While this was rare, and clearly happens around the world, it is not acceptable. This committee was created in order to strengthen the safety net and to create systems that guarantee that any child admitted to the Johns Hopkins Children’s Center will receive the best care possible with the goal of avoiding all cardiopulmonary arrests on the wards, and for those that are not preventable, to ensure that they will receive optimal basic and advanced life support.

Program Description
The purpose of this sub-committee is to improve patient safety through regular review of topics regarding the cause, management, outcomes and prevention of cardiopulmonary arrest of children cared for within Johns Hopkins  Hospital and at the Kennedy Krieger Institute. The Pediatric CPR Advisory Committee will exist as a sub-committee to the hospital wide CPR Advisory Committee. As such the sub-committee will report to the hospital wide CPR Advisory Committee and to the Children’s Center Pediatrician in Chief and Physician Advisor. The sub-committee will meet monthly, sub-groups may meet more frequently.The sub-committee will have three primary mandates:

  1. to review the infrastructure and competency of the current Johns Hopkins Children’s Center system of response for pediatric cardiopulmonary arrests and/or life threatening episodes
  2. to create a system of ongoing data collection for continuous assessment of every cardiopulmonary arrest, including: events leading to arrests, details of the actual resuscitation efforts and eventual outcomes of all pediatric patients who suffer a cardiopulmonary arrest
  3. to develop a system of reporting the results of this ongoing assessment to the
  4. hospital wide CPR Advisory Committee and to the Children’s Center Pediatrician in Chief and Physician Advisor

The sub-committee will establish methods to identify each of these events in order to initiate the Continuous Quality Improvement process. The sub-committee will then develop a template and process of appropriate data collection which is consistent with current standards of arrest management data collection using the Utstein Style of reporting, as well as meeting JCAHO standards. The sub-committee will direct analysis of the acquired data to identify system weaknesses and develop modifications to current processes related to the management and outcomes of resuscitation. The quality improvement process will include review of all aspects of arrest management including but not limited to: communication, curriculum development and review, equipment availability and maintenance, job assignments of code team members and maintenance and introduction of technology related to arrest management and prevention.

(From the Pediatric CPR Advisory Committee, from June 2003.)

Team Members
Elizabeth Hunt – PICU Attending, Member of JHH CPR Advisory Committee, assists with mock code program

Children’s Center Staff Assistant
Chairman of Risk Management
Pediatric Residency Program Director
Director of Quality and Safety Initiatives for Children’s Center
Head of Pediatric Nursing
Pediatric Nurse Educators
Nurse Managers
Respiratory Therapy Manager
Pharmacy Manager
Pediatric Chief Resident
Pediatric resident representative
PICU fellow representative
Pediatric Nursing Shift Coordinator representative
Pediatric representative to CPR Advisory Committee
Pediatric Surgery/Trauma representative
CPS/ECMO Manager
KKI Representative
Clergy Representative

Program Goals
The goal of the Pediatric CPR Advisory Committee is to function as a continuous quality improvement committee, with the target of having no preventable pediatric cardiopulmonary arrests on the wards of the Johns Hopkins Children’s Center and to provide world class care to children who do suffer any type of medical emergency while in the Children’s Center.

Program Implementation
Monthly meetings of the Johns Hopkins Pediatric CPR Advisory Committee with sub-committee meetings focused on acute issues. The committee is very effective because of its multidisciplinary nature and the fact that most of the decision makers are at the table each month.

Program Results

  • Implementation of a Pediatric Rapid Response Team  in October, 2004
  • Roll out of standardized biphasic defibrillators to Children’s Hospital
  • Regular review and update of Pediatric Cardiac Arrest Drug Box
  • Regular review and update of Pediatric Code Cart
  • Addition of Pharmacy, Clergy and Pharmacy to Pediatric Rapid Response Team
  • Creation of new med bag carried by Pharmacist to all Pediatric Rapid Response Teams with meds that may be needed emergently but can’t be kept in Pediatric Cardiac Arrest Drug Box because of: being a controlled substance, needing to be refrigerated, etc…
  • Creation of database to systematically review each Pediatric Rapid Response Team call each month, any quality problems identified, and to regularly review system wide data to look for any trends indicating a problem that should be investigated
  • Created a new policy for medical emergencies that occur in the new Pediatric Ambulatory building, prior to team moving in:
    • Created new Pediatric Ambulatory Rapid Response Team
    • Run monthly mock codes at the Pediatric Ambulatory Building to identify and address weaknesses in the system for on-site medical emergencies
  • Initiation of Parent Requested Pediatric Rapid Response Team calls, 2/2005
  • Current initiative for implementing a Parent Initiated Pediatric Rapid Response Team – i.e. Condition “H”, goal go-live date 07/2007.

What People are Saying
Many groups contact us about how to implement a Pediatric Rapid Response Team and we are happy to share our experiences. We are part of the AAMC Pediatric Rapid Response Team Collaborative and are an IHI Pediatric Rapid Response Team Mentor Hospital. Dr. Hunt, Cathy Garger and other members of our team have spoken about Pediatric Pediatric Rapid Response Teams in many forums, including: IHI national web cast, NRCPR User Annual Conference, International Medical Emergency Team Conference and the American Heart Association Science Symposium.

How the Josie King Foundation Contributes
The Josie King Foundation has been integral in that it provides salary support to Dr. Hunt, to ensure that she has adequate time to dedicate to this important committee.

For More Information
Please contact info@josieking.org.