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Abstract

Objectives: The aim of this study is to evaluate the amalgamation and maturation of a Paediatric Intensive Care Outreach Service (PICOS) with a Rapid Response System (RRS) and associated outcomes over a ten year period. Methods: Single centre retrospective study analysing patient outcomes within the context of significant organisational changes introducing a track & trigger RRS called Between the Flags (BTF), and evolution of this system to electronic observation charting and alerts (eBTF) in a tertiary metropolitan children’s hospital. Children on inpatient wards who required urgent activation of the RRS and admission to the Paediatric Intensive Care Unit (PICU) between 2009-2018 were included. Three cohorts were identified according to the system changes— Pre BTF (2009-2011), BTF (2012-2017) & eBTF (2017-2018). Results: The PICOS dose (number of activations per 1000 hospital admissions) increased with the introduction of BTF and the RRS and this trend continued following eBTF. The number of PICU admissions via the PICOS did not vary across the decade. When comparing the pre-BTF to the BTF group, PICU mortality decreased (p<0.05), Paediatric Index of Mortality 2 Risk of death (PIM2ROD) scores improved, and hospital length of stay decreased (p<0.05) in the BTF group. Conclusions: Introduction of a track and trigger RRS and electronic charting augmenting an existing PICOS is associated with increasing dose and workload, with no significant impact on PICU admission rates or length of stay. PICOS patient mortality has notably decreased with the introduction of a RRS, however this impact was not sustained with the addition of electronic charting and alerts in the patient medical record.

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