Developing the PRRS involved changing behaviors among a large number of multidisciplinary care givers surrounding the care management of clinical deterioration of non-ICU hospitalized pediatric patients. This system eliminated chain of command delays, empowerment barriers, and communication failures across system silos of care. A study was completed around the implementation of this system to determine the effects of the system on duration of pediatric inpatient clinical instability as well as the effect on inpatient pediatric cardiac arrest rate.

MethodsPRRS Implementation

We conducted an interrupted time-series study coupled with a retrospective chart review to evaluate the effects of a pediatric rapid response system. All patients in the 136-bed pediatric hospital were considered in the study from August 2003 – May 2007. A 4-component pediatric rapid response system was incorporated over eight months as outlined in the figure. The main outcome measures were cardiac arrest rates and duration of predefined clinical instability prior to assessment by critical care personnel.

ResultsPRRS chart

The mean time interval between cardiac arrests increased significantly with the establishment of the rapid response system from a baseline of 2512 to 9418 patient days. The median duration of clinical instability decreased from 9h 55min to 4h 15min post intervention (p = 0.028).


Hanson C, Randolph GD, Erickson J, Mayer C, Bruckel J, Harris B, Willis T. A reduction in cardiac arrests and duration of clinical instability after implementation of a paediatric rapid response system. Qual Saf Health Care. 2009;18:500-504.

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