Winnipeg Childrens Hospital

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Winnipeg Childrens Hospital Implementation of a
Pediatric Rapid Response Team
Contestant E

• Aim
• The aim of the Pediatric Rapid Response Team
  (PRRT) safety project was to decrease pediatric
  ward codes to 0.20 codes / 1000 discharges. This
  goal was to be met within one year through
  earlier recognition, prompt PICU involvement, and
  appropriate timely interventions.
• Key Points
• WCH baseline code rate ranged from 0.22 to 1.60
  codes / 1000 discharges. This indicated that
  there was opportunity for improvement.
• Completion of the IHI mortality diagnostic matrix
  (IHI, 2006) of 50 deaths prior to the initiation
  of the pilot, determined that 24 of deaths were
  in children who were not expected to die at the
  time of admission to WCH.
•  
• Measures
• Codes per 1000 discharges
• Days between codes
• Number of PRRT calls per month
• Number of PICU admissions post PRRT call per
  month
• Post PRRT call ward evaluation
• Post call PRRT process evaluation
• Staff satisfaction PRRT members, PICU team, Ward
  staff
• IHI Mortality Matrix (pre and post PRRT)

Contestant A Contestant B Contestant
C Contestant D Home
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Winnipeg Childrens Hospital Implementation of a
Pediatric Rapid Response Team
Contestant E

• Changes  
• The changes were pilot tested with PDSA
  methodology on one unit for four months prior to
  a planned spread to all inpatient units.
• Use a standardized format that included SBAR
  communication linked with the PRRT documentation
  record.
• Generate feedback loops with written evaluations
  for each PRRT call.
• Incorporate common language by the use of a
  standard salutation, flow of information at the
  bedside and on departure from ward.
• Create multimodal communication channels such as
  the Published Safety newsletter, grand rounds,
  poster presentation and emails.
• Optimize inventory with a PRRT equipment pack.
• Signage indicating activation criteria posted on
  wards, and individual lanyard cards were given to
  all health care providers.
• Celebrate success by the sharing of stories from
  the health care team and families.
• Use multiple educational strategies email,
  poster presentation, case studies and simulation
  testing. Develop a standard set of educational
  materials and incorporate real case based
  learning.
• The change process was led by the team leaders,
  with frequent evaluation of processes.

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Winnipeg Childrens Hospital Implementation of a
Pediatric Rapid Response Team
Contestant E
Results

• Chart A demonstrates the number of calls per
  month to the PRRT. The PRRT averages 14 call per
  month with a range of 6 to 26 demonstrating the
  service was being utilized with the desired
  frequency. Ninety five percent of calls are
  deemed appropriate.
• Chart B illustrates the total number of calls
  annually in relation to reassessments and total
  number of PICU admissions. The admission rate
  after the PRRT was activated is between 25 to
  35. Note 2006 is the pilot ward data and 2008
  represents the first 8 months.

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Winnipeg Childrens Hospital Implementation of a
Pediatric Rapid Response Team
Contestant E
Results
This chart demonstrates a trend of decreasing
ward codes per 1000 discharges, with the goal set
below the benchmark of .20 codes per 1000
discharges. Data to date demonstrates a
decreasing trend, but due to the relative
infrequency it will take several years to
determine true impact. Mission accomplished!
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Winnipeg Childrens Hospital Implementation of a
Pediatric Rapid Response Team
Contestant E

• Lessons Learned
• The PRRT has had a significant impact on patient
  care.
• The establishment of the PRRT has greatly
  improved relationships with the ward staff it
  has also supported education at the front line.
• When a patient becomes sicker, the PRRT
  supports processes of care that frequently
  eliminate urgent transfer to the PICU, rapid
  clinical deterioration and ultimately a code.
• Team work is critical to success.
• Respect is critical to ongoing success.
• Priority must be given to free up members of the
  PRRT from their other duties in order for them to
  attend all calls.

Contact InformationJannell Plouffe RN, BScN, MN,
Winnipeg Childrens Hospital, jplouffe_at_hsc.mb.ca