Optimizing Pediatric Rapid Response Teams: Stakeholder Focus Groups

Abstract

OBJECTIVES Rapid response teams (RRTs) can improve outcomes in both adult and pediatric hospitals. Most pediatric hospitals have RRT-type systems; however, little is known about stakeholders’ perspectives regarding how to optimize RRT quality and efficiency. We aimed to better understand multidisciplinary stakeholder perspectives on how to improve the RRT process. METHODS We held 4 stakeholder focus groups including floor nurses, pediatric trainees (interns and residents), pediatric hospitalists, and the responding PICU team (PICU fellows and nurses). We used deductive coding to identify potential solutions and subsequent themes. RESULTS Focus groups identified 10 potential solutions within 3 major themes. Themes included (1) the value of a standardized RRT workflow based on stages, (2) the benefit of promoting a safety culture, and (3) the need to implement ongoing RRT education. Stakeholders described a shared mental model of RRT workflow with important events or tasks occurring within each stage. These stages were coded as 1: trigger, 2: team arrival and information sharing, 3: intervention, and 4: disposition and follow-up. Additional proposed solutions included waiting for the entire team to arrive, a systematic information sharing process, and closed loop communication for follow-up plans for patients remaining on the general care floor. CONCLUSIONS RRT stakeholder focus groups provide valuable insight into efforts to optimize RRT events. Standardizing RRT workflow into a staged process may facilitate communication and information sharing. Promoting a culture of safety and implementing ongoing education may help reinforce RRT standardization.