135 - Evaluating the Utilization and Sustainability of Family-Initiated Rapid Response Activations

Poster Number: 135
Publication Number: 135.1545

Background: Families have valuable insight into the clinical status of their children, and family-initiated rapid response activations (FIRRAs) provide an additional key avenue for escalation of care. A new, formalized FIRRA process was implemented at our institution in July 2021. The authors aimed to evaluate the overall uptake of this program, its utility in identifying patients who require escalation of care to the ICU, and its impact on total number of critical assessment team (CAT) activations at our institution.

Objective: To evaluate the number of FIRRAs after initiating a new FIRRA program at our institution, and to analyze patient characteristics and patient disposition for each activation.

Design/Methods: FIRRAs from July 2021-September 2023 were extracted from the electronic medical record. For each FIRRA, patient disposition was categorized (transfer to PICU or remained in current unit), hospital service was categorized, and patient demographic data were collected. Patient medical complexity was assessed using the complex chronic conditions (CCC) system, version 2. Each FIRRA was analyzed to determine if it was associated with a code outside the ICU. The percentage of CAT activations initiated by families was tracked monthly to monitor the impact of the FIRRA process on CAT operations. Statistical process control (SPC) charts were generated.

Results: There were 41 FIRRAs, 14 (34%) of which required ICU transfer within 12 hours (Table 1). One FIRRA resulted in a code outside the ICU. The following characteristics were present in the majority of FIRRAs: 26 (63%) activations were for male patients, 38 (93%) were for primarily English-speaking patients, 23 (56%) were for patients with commercial insurance, and 34 (83%) were for patients with at least 1 CCC. After implementation, there was a mean of 1.5 FIRRAs per month (Figure 1). FIRRAs represented 2.59% of monthly CAT activations (Figure 2).

Conclusion(s): Families can detect early patient deterioration, and FIRRAs are a valuable method for escalation of care. A FIRRA process was initiated and sustained with consistent hospital adoption and utilization, without an increased burden on our institution’s rapid response team. Further analysis will be conducted to determine how the FIRRA patient population compares to that of our hospital overall, to ensure that the FIRRA process is being communicated and enacted equitably among all patients.