Textbook of Rapid Response Systems - Concept and Implementation (Feb 6, 2025)_(3031679504)_(Springer).pdf

Preface
Contents
Part I: Rapid Response Systems and Safety of Patients in Hospital
	1: The Voice that Is Missing: The Evolving Role of Patients and Families in Escalation of Care
		Introduction
		Aishwarya Aswath, Western Australia, Australia: Aishwarya’s CARE Call
		Rory Staunton, New York, USA: “Rory’s Regs”
		Erin Flatley, Florida, USA: Sepsis Alliance
		Lewis Blackman, South Carolina, USA: Lewis Blackman Act
		Josie King, Maryland, USA: Condition Help
		Vanessa Anderson, New South Wales, Australia: Between the Flags
		Ryan Saunders, Queensland, Australia: Ryan’s Rule
		Hiyaan Kapil, Queensland, Australia, and Amrita Lanka, Victoria, Australia: Cultural Awareness
		Differing Opinions
		Rapid Response and the Patient Experience
		Discussion
		Conclusion
		References
	2: Causes of Failure to Rescue
		Introduction
		Patient Factors
			Static Factors
			Dynamic Factors
		Tasks and Technology Factors
			Tasks
			Technology
		Individual (Staff) Factors
			Cognitive Dispositions to Respond (CDR)
			Nurse Education and Experience
		Team Factors
			Teamwork and Communication
		Work Environment
			Staffing Levels
			Staffing Models
			Physical Environment
		Organizational Factors
			Hospital Procedural Volume and Type
			Safety Culture
		Conclusion
		References
	3: Rapid Response Systems and the Culture of Safety
		Introduction
		Hospital Culture and the Need for Rapid Response Systems
		Hospital Culture and the Implementation of RRSs
		The Impact of an RRS on Hospital Culture
		Understanding and Assessing Organisational Safety Culture in Hospitals
		RRSs into the Future: Changing Hospital Culture and Changing the Delivery of Acute Care
		References
	4: System Thinking: Standing on the Shoulders of Giants or What Can We Learn from the Patient Safety Movement?
		Introduction
			Patient Story
		Adverse Events
			“It Is Not Bad People, But Bad Systems”
			Patient Safety
			Suboptimal Healthcare Quality
			Patient Safety as a Dimension of Quality
		Quality of Care as a System Property
			“Care Is Based on Continuous Healing Relationships”
			“Care Is Customised According to Patient Needs and Values”
			“The Patient Is the Source of Control”
			“Knowledge Is Shared Freely”
			“Decision-Making Is Based on Evidence”
			“Safety Is a System Property”
			“Transparency Is Necessary”
			“Needs Are Anticipated”
			“Waste Is Continuously Decreased”
			“Cooperation Between Clinicians Is a Priority”
		Conclusion
		References
	5: A Brief History of Rapid Response Systems
		Principles
		References
	6: RRS’s General Principles
		Introduction
		Overview
		The Afferent Limb
		The Efferent Limb
		The Administrative Limb
		The Quality Improvement Limb
		Summary
		References
Part II: The Afferent Limb
	7: An Overview of the Afferent Limb
		Introduction
		Improving the Function of the Afferent Limb
			Improving Regular Monitoring and Assessment
		Ensuring Vital Sign Measurements Are Accurate
		Ensuring Vital Sign Measurements Are Accurately Recorded
		Systems for Identifying the Sick or Deteriorating Patient
		MET Criteria
		Early Warning Scores (EWSs)
		Efficiency of EWS and MET Criteria
		Other Clinical Observations that May Be Used to Trigger Rapid Response Systems
		The Need for Standardisation
		Calling for Assistance
		The Role of Technology in Improving the Afferent Limb
		Recent Developments
		Summary
		References
	8: The Interpretation of Vital Signs and Other Vital Bedside Information: Expanding the Paradigm
		Introduction: What Information Is Needed at the Bedside?
		More Information Is Needed than the Vital Signs Can Provide
		Symptoms
		Non-specific Symptoms
		Pain
		Fever
		Breathlessness
		Intuition and Other Worrying Signs of Illness
		Can Dying Unsalvageable Patients Be Identified?
		Mental and Physical Function
			Functional Status
			Mental Status
		Nutrition
		Vital Signs: Harbingers of Death or Aids to Survival?
			Normal Values
			Trends
			How Often Should Vital Signs Be Measured?
			Obtaining Insights into Pathophysiology from Vital Signs
		Laboratory Tests, Biomarkers, and ECG
		What the Patient Wants: The Most Vital Information of All
		Conclusion
		References
	9: Track-and-Trigger System: Identifying and Predicting Patient Deterioration through Scores and Algorithms
		Background
		Defining Patient Deterioration
		Vital Sign Monitoring
		Single-Parameter Track-and-Trigger Systems
		Early Warning Scores
			In Silico Validation
			Effect on Patient Outcomes
			Strengths and Limitations
		Machine Learning and “Artificial Intelligence”
		Future Directions
		References
	10: Continuous Vital Sign Monitoring for Early Detection of Deterioration outside High Intensity Care Settings
		Introduction
		Why Monitor Continuously?
		What Is Continuous Monitoring?
		What Parameters Should Be Monitored?
			Respiratory Parameters
			Circulatory Parameters
			Other Parameters
		The Ideal Monitoring System
		Importance of Clinical Validation
		Complexity of Clinical Implementation
		Afferent Limb
			Sensor Technology
			Signal Processing, Alarm Strategy and Caregiver Communication
		Efferent Limb
		Does Continuous Monitoring Reduce Workload?
		Does Continuous Ward Monitoring Improve Outcome?
		Future Perspectives
		Summary
		References
	11: When Patients (and Families) Raise the Alarm: Patient- and Family-Activated Escalation Systems as a Safety Strategy for Hospitals
		Introduction
		Role of Patients and Families in Patient Safety
		What Is a Patient- and Family-Activated Rapid Response System?
		Patient- and Family-Activated Escalation Systems’ Research Evidence
		Challenges Implementing Patient- and Family-Activated Escalation Systems
		Evaluating Patient- and Family-Activated Escalation Systems
		Looking to the Future: An Integrated Model of Escalation
		Conclusion
		References
	12: The Impact of Delayed Rapid Response System Activation
		Background: Principles of the Rapid Response System
		Definition, Measurement, Classification of Delayed MET Activation
			How Should Delayed Activation Be Defined?
			How Should Delayed MET Activation Be Classified?
			How Should We Measure Delayed Activation?
			What Are the Limitations in the Measurement of Afferent Limb Failure?
			How Often Is RRS Activation Delayed?
			What Are the Consequences of Delayed MET Activation?
		Impact on Clinical Outcomes
		Impact on Organizational Culture
		What Are the Causes of Delayed MET Activation?
		Which Strategies Can Help to Reduce Delayed RRS Activation?
		Conclusion
		References
Part III: The Efferent Limb
	13: Overview of the Efferent Limb
		Rapidly and Easily Alerted
		Response Within Minutes to Any Site
		Predetermined Skilled Personnel
		Team-Trained
		Preorganized “Ready-to-Go” Equipment
		Ability to Rapidly Access Backup or Supporting Resources
		Ability to Record Events
		Ability to Rapidly Access Data Required for Rapid Diagnosis
		Ability to Overcome Bureaucratic, Sociological, and Logistical Barriers
		Conclusion
		Bibliography
	14: Tiered Rapid Response Systems
		Introduction
		Background
		Prominent Examples of Tiered RRSs
		Afferent Limb: Triggers for Escalation of Care
		Efferent Limb: Responding Teams and Interventions
		Benefits of Tiered RRSs
		Challenges Impacting Tiered RRSs
		Areas for Future Research
		Summary
		References
	15: MET: Physician-Led RRTs
		Introduction
		Principles Underlying the Physician-Led RRT/MET
			There Are Warning Signs
			There Is Time for Intervention
			There Are Effective Treatments/Early Intervention Improves Outcome
			The Expertise Exists and Can Be Deployed
		Composition and Team Leader of a Physician-Led RRT/MET
		Operations and Governance of MET
		Why Do Patients Need MET Calls?
		What Does the Physician-Led MET Do
		What Are the Advantages and Disadvantages of Physician-Led RRT
		Physician-Led RRTs: The Evidence Behind Their Use
		References
	16: Use of Rapid Response Team Protocols
		Introduction
		Protocols for Team Activation and Composition
		Delegation or Medical Directives
		Specific Algorithms for Clinical Syndromes
			Stroke Response
			Sepsis
		Conclusion
		Rapid Assessment Critical Events (RACE) Team Medical Directives
			Medical Directive
				Care of the Patient with Circulatory Compromise
		References
	17: Equipment, Medications, and Supplies for a Rapid Response Team
		Introduction
		Ward Emergency Trolley: “Crash Cart”
		Rapid Response Team/Medical Emergency Team Trolley Overview
		RRT Equipment and Medication for Endotracheal Intubation
			Airway Equipment
			Medications for Endo-Tracheal Intubation
		Medication Selection
		Details of MET Cart-Trolley Layout
		Specialty Cart-Trolleys
		Pharmacy Emergency Trolley Exchange Process
		Restocking Medications in the Emergency Trolley
		Additional Methods for Supplying Emergency
		Barriers to Implementation
		Summary
		References
	18: End-of-Life Care II: Rapid Response for Dying Patients Without NFR Orders
		Introduction
		End of Life and the Acute Care Hospital System
		End-of-Life Care and the Rapid Response System
		Characteristics of End-of-Life Care RRS Calls
		Assessment and Triage of RRS Calls to Identify End-of-Life Care Issues
		The Clinician’s Role in Identifying End of Life
		Patient and Family Preparedness for End-of-Life Care
		Moral Distress and Ethical Challenges
		Logistic and Process Issues Surrounding End-of-Life Care RRS Calls
		Pharmacological Management of EOLC RRS Calls
		Summary
		References
	19: Crisis Teams for Obstetric Patients
		Introduction
		Background and Justification
		Design and Introduction
		Creating Leadership and Response Design
		Responders
		The Obstetric Rapid Response System
		Activation Criteria
		Staff Education
		Response Team Training
		Data Collection, Review, and Process Improvement
		National Initiatives for Rapid Response Teams in Obstetric and Gynecologic Settings
		Early Experience at a University Women’s Hospital
		Family and Patient Education
		Quality and Safety Evaluation
		Optimal Response Team and Their Training
		Leadership of the Obstetric Response Team and Roles of Team Members
		Triggering Criteria and Overcoming Barriers to Activating the RRT
		Sustaining Post-Event Debriefing and Long-Term Post Hoc Analyses for Quality of Process and Outcome
		Effectiveness of Patient and Family Education about the Process
		Conclusion
		References
	20: Rapid Response System in the Emergency Department
		Introduction
		Clinical Deterioration in Emergency Department Patients
		Systems for Recognition and Response to Deteriorating Emergency Department Patients
			Recognition of Deteriorating ED Patients (ED RRS Afferent Limb)
			Responses to Deteriorating ED Patients (ED RRS Efferent Limb)
		Outcomes and Implications of Emergency Department Deterioration
			Reducing Emergency Department Deterioration and Subsequent Ward Deterioration Events
		Future Considerations
		References
	21: “Second Victims”: Care for Caregivers Using a Rapid Response Model
		Introduction
		The Second Victim Phenomenon: An Overview
		Peer Support Model Framework
		The Peer Supporter Role
		Peer Support Rapid Response Teams in Action
		University of Missouri Health Care: forYOU Team
		ChristianaCare’s Peer Support and Center for WorkLife Wellbeing
		Conclusion
		References
	22: Hospital Rapid Response Systems and Disasters
		Hospitals and Disasters
		The RRS in Disasters
		RRT Training Curriculum for Hospital Disasters
		Equipment
		RRS Activation and Communication in Hospital Disasters
		Networking
		RRS Response and Hospital Disaster Scenarios
		References
	23: Other Efferent Limb Teams: Crises That Require Specialized Resources
		Stroke Team
		Pulmonary Embolism Response Team (PERT)
		Trauma Team
		Blood Administration Team (BAT)
		Chest Pain/Coronary Syndrome Team
		Condition L (Lost Patient)
		Difficult Airway Team (DAT)
		Tracheostomy (Trachy) Team
		Pediatric Response Team (See Further Chapters in the Pediatric Section of the Textbook)
		Condition M (Behavioral Critical Event)
		Sepsis Team
		End-of-Life/Palliative Care Crisis Team
		Summary
		References
Part IV: The Administrative Limb
	24: Measuring Complex and Macro Research in Rapid Response Systems
		References
	25: Leadership and Governance of the Rapid Response System
		Why Is a Governance Arm Needed?
		The Deteriorating Patient Committee (DPC)
			DPC Subcommittees
			The Deteriorating Patient Coordinator
			The Importance of an Organisational Approach
		Administration of the RRT Is Performed by a MET Panel
			Roles and Responsibilities of the MET Panel
			Training of the RRT Nurse Members
			Reviewing Critical Incidences Related to the RRT
		References
	26: The Resuscitation Officer: Responsibilities and Impact
		Introduction
		Resuscitation Officer Responsibilities and Impact
			Quality Improvement Activities
				Cardiac Arrests in General Ward Patients
				Team Conference
				Effective Management of the Team
				CPR Case Review and Data Collection
				Definition of Predictable Cardiopulmonary Arrest (CPA)
				Definition of Preventable CPAs (Potential Avoidability)
			Education and Teamwork Improvement
		References
	27: Ward Staff Education in the Age of Rapid Response Systems
		Introduction
		A Solution to a Real Problem: What Ward Staff Need to Know about Rapid Response Systems?
			Reception to RRS Implementation
		Does Education of Ward Staff on Deterioration Improve Any Measurable Outcome?
			What Has Worked?
			Specific Educational Programs
		What Should Be Taught to Physicians and Nurses Who Work on the Wards?
			Physiology of Deterioration
			Immediate Interventions to Stabilize Patient While RRT Is Summoned
			Leadership training and the Role of Simulation
		Conclusion
		References
	28: Simulation-Based Training for Rapid Response Systems in Medical Education, a Review
		Introduction
		Skill-Based Simulation Methods
			Task Trainers
			Micro Skill Trainers
			Individual and Just-in-Time Training
			Standard Patients and Hybrid Simulators
			Preemptive Briefings
			Virtual Reality
			Virtual Worlds
			Human Patient Simulators
			Low-Technology Options
		Management-Focused Simulations
			Crisis Resource Management
			Difficult Conversations
		Simulation Environments
			Center-Based Simulation
			In Situ Simulation
		How to Run an Effective RRT Simulation
			Design
			Prebriefing
			Simulation in Action
			Post-event Debriefing
			Best Practices for In Situ Simulation
		Specific Disease Management Scenarios
			Mock Code
			Sepsis Drills
			Hemorrhage
			Mental Status Change
		Conclusion
		References
	29: Crisis Resource Management: Training the Responders
		Origins of Crisis Resource Management
		Translation of CRM into Healthcare Contexts
		Components of Crisis Resource Management
		Leadership and Teamwork
		Communication and Situational Awareness
		Support and Resources
		What Is the Current State of CRM Training in Healthcare?
		Conclusion
		References
Part V: Quality Assurance
	30: Measuring the Quality of Rapid Response: Applying the Quadruple Aim to Patient Safety
		Introduction
		Existing Quality Metric in National Systems
			Case Study 1: The UK
			Case Study 2: The USA
			Case Study 3: Australia
			Case Study 4: The Netherlands
		The Third International Consensus Conference: Quality Metrics for RRSs
			First Aim: Population Health
			Second Aim: Patient Satisfaction
			Third Aim: Cost
			Fourth Aim: Joy at Work
		International Comparison of Metrics
		Conclusion
		References
	31: Rapid Response System Informatics
		Introduction
			Which Data to Collect
				Operational
				Patient Identifiers and Demographics
				Patient Clinical Data
				Outcomes
				RRS-Specific Data
			Data Collection
			Data Storage
			Data Validation
			Data Analysis and Reporting
			Technical Governance
		Conclusion
		References
	32: Emerging Research Topics
		Drivers for Change in the Recognition and Treatment of Deteriorating Patients
		Research Perspectives for the Afferent Limb
		Efferent Limb: Perspectives for the Response to the Risk of Deterioration
		Research Opportunities for the Administrative and Audit Limb of Rapid Response
		Conclusion
		References
	33: The Role, Determinants and Impact of RRS on End-of-Life Care Orders
		Original Intention of the MET/RRS
		Is the Patient Dying or Reversibly Deteriorating?
		Epidemiology of RRT Involvement in End-of-Life Care and Treatment Limitations
		The Timing of RRS Activations for Dying Patients
		Factors Contributing to RRTs as Treatment Limiters
		Impact of De-escalation of Care via Treatment Limitation Orders
		Is End-of-Life Care Guidance the Responsibility of the RRS?
		Is RRT-Issued DNR Low-Value or High-Value Care?
		Potentially Inappropriate Involvement of RRS in End-of-Life Decisions
		Appropriate and Valid Involvement of RRS in End-of-Life Care
		Cost Implications of Avoidable RRS Activation
		Potential Solutions to Late Involvement of the RRS Team in End-of-Life Care
		Implications for Clinicians and Policymakers
		Conclusion
		References
	34: End-of-Life Care II: Rapid Response for Patients with End-of-Life Care Needs
		Introduction
		End of Life and the Acute Care Hospital System
		End-of-Life Care and the Rapid Response System
		Characteristics of End-of-Life Care RRS Calls
		Assessment and Triage of RRS Calls to Identify End-of-Life Care Issues
		The Clinician’s Role in Identifying End of Life
		Patient and Family Preparedness for End-of-Life Care
		Moral Distress and Ethical Challenges
		Logistic and Process Issues Surrounding End-of-Life Care RRS Calls
		Pharmacological Management of EOLC RRS Calls
		Summary
		References
	35: Rapid Response Systems and the Management of End of Life
		Introduction
		Detection of End of Life in Patients Subject to RRS Calls
		The Failure to Recognise Terminally Ill Patients
		Making Hospitals Safer for the Dying
		Improving Systems to Recognise End of Life in Hospitalised Patients
		Involvement of Patients in End-of-Life Care
		Conclusion
		References
Part VI: Rapid Response Around the World
	36: The Rapid Response System in Australia and New Zealand
		History: Adverse Events and the Introduction of Rapid Response Teams
		Importance of Centralised Governance: Commissions and National Standards
		Differences in Afferent Limb Escalation
		Epidemiology of a MET Patient in Australia and New Zealand
		Recommendations of the First Safety and Quality Conference on RRTs
		College of Intensive Care Medicine and ANZICS Joint Position Statement
		Evidence for Effectiveness of a Tiered Approach to Escalation and Response
		References
	37: A Rapid Response System in Europe
		Introduction
		Rapid Response Systems (Critical Care Outreach) in the UK
			The Beginnings of Critical Care Outreach
			Standardized Early Warning Scoring: A Common Language of Acuity of Illness and Risk of Deterioration
			Critical Care Outreach in the Present Day
		Rapid Response Systems in Finland
		Rapid Response Systems in Italy
		Rapid Response Systems in Spain
		References
	38: RRS in Asia
		Rapid Response System in Korea
		Rapid Response System in Japan
			History of RRS in Japan
			Current RRS Situation
			Ongoing Research Projects
		Rapid Response System in Singapore
		References
	39: Rapid Response Team System in Central and South America
		References
	40: In-Hospital Rapid Response Systems in Sub-Saharan Africa
		Introduction
		The Setting
		Stakeholder Engagement and Administrative Support
		Rapid Response Triggers
		The Rapid Response Team
		Rapid Response Education
		Implementation
		References
Part VII: Pediatric and Neonatal Rapid Response Systems
	41: Pediatric Rapid Response Systems
		Introduction
		References
	42: Recognition of Clinical Deterioration in Children
		Recognising Evolving Critical Illness
		Paediatric Track and Trigger Tools
			Threshold-Based Systems
			Scoring Systems
			Scoring Versus Threshold-Based Systems
			Composition of Paediatric Track and Trigger Tools
			Characteristics of Effective Paediatric Track and Trigger Tools
			Mechanisms by Which Paediatric Track and Trigger Tools May Work
			Assessing if a Paediatric Track and Trigger Tool Is Effective
			Limitations in the Use of Paediatric Track and Trigger Tools
			Future Approaches for Recognising Deterioration in Children
		Conclusion
		References
	43: Intensity of Care in Pediatric Rapid Response Systems
		Introduction
		Definitions of Escalation and De-escalation
		Domains for Matching Care with Need
		Domain 1: Decisions to Adapt the Intensity of Care
		Domain 2: Activation
		Factors Impacting Activation of Escalation Plans
		Standardization and Individualization of Escalation Process
		Family Caregiver Engagement in the Activation Domain of Escalation of Care
		Communication for Rapid Escalation
		Operational Escalation Processes
		Domain Three: Organizational Sustainment
		Technical Developments and Innovation to Support Real-Time Situation Awareness of Deteriorating Children with Automation of Escalation
		Conclusion
		References
	44: Pediatric Rapid Response Systems: Redirection of Care
		Case Example
		Brief Overview of Pediatric Rapid Response Teams with Special Attention to Integration of Palliative Care Skills and Roles
		Pediatric RRT Consultation for Patients at High Risk of Death: Specific Responsibilities and Expectations
		Primary Team
		Rapid Response Team Skill Sets Relevant to Assessing Redirection of Care
			Communication
			Symptom Management
			Staff Support
		Practical Strategies for Redirection of Care in the Pediatric Rapid Response Setting
			Pre-Discussion
			Introductions of Roles
			Prognostic Awareness Assessment
			Clinical Status Update
			Attend to Expected Emotion
			Obtain Input from All Stakeholders
			Proposed Interventions
			Reassurance
			Elicit Questions and Concerns
			Redirection Towards a Comfort-Focused Plan (as Appropriate)
			Potential Disposition Recommendations
		Special Considerations for Redirection of Care by an RRT in Pediatrics
		Case Resolution
		Conclusion
		References
	45: The Rapid Response System Team: Building and Maintaining
		Introduction
		Frontline Team Members/RRT Personnel
		Surveillance and Outreach
			Equipping Your RRT
		Clinical Informatics, Data, and Oversight
		Application and Implementation
		Education
		Special Circumstances and Future Considerations
		Administrative Leadership
		Key Challenges/Aims
		Conclusion
		References
	46: Parents, Patients, Ward Clinicians, and Other Stakeholders in Rapid Response Systems
		Rapid Response System Stakeholders
		Patients
		Parents and Families
		Frontline Nurses
		Supervising Nurses/Charge Nurses
		Physicians and Other Prescribing Clinicians
		Medical Trainees
		Conclusion
		References
	47: The Approach to the Child with Hypotension
		The Measurement of Blood Pressure
		Components of Blood Pressure
			Systolic Blood Pressure
			Diastolic Blood Pressure
			Pulse Pressure
			Mean Arterial Pressure
			Autoregulation and Regional Circulations
		Clinical Assessment
			History and Physical Examination
			Investigations
		Interpretation and Causes of Hypotension
		Treatment of Hypotension
		References
	48: Practical Approach to the Child with Rapid Breathing
		Introduction
		Case Studies
			Case Study 1: Upper Airway Obstruction
			Case Study 2: Asthma
			Case Study 3: Cardiac Failure
			Case Study 4: Sepsis
		Epidemiology of Respiratory Rapid Response Reviews
		Assessment of the Child with Respiratory Distress
		Concerning Signs/Features
			Assessment to Establish Diagnosis
		Diagnostic Approach
		Management of Signs and Symptoms
			Medications for Common Presentations
				Bronchiolitis
				Asthma
				Croup
				Congestive Cardiac Failure (CCF)
			Escalation of Care or Observation
				Ward-Based Management
				Transfer to PICU/HDU
		Summary
		References
	49: Approach to the Child with Reduced Level of Consciousness
		Introduction
		Non-neurologic Illness and Depressed Level of Consciousness
		Case Example
		First Priorities for the RRT
			Identifying Immediate Life-Threatening Conditions and Treatment
		Collaboration
		Focused Neurological Assessment and Condition-Specific Treatment
		Emergent Interventions (Table 49.2)
		Diagnostic Workup
		Mimickers of Reduced Level of Consciousness
		Case Resolution
		Conclusion
		References
	50: Neonatal Rapid Response Systems
		Defining a “Rapid Response System” for the Newborn
			The Emerging Model of Neonatal Care
		Design and Safety Considerations
			Prevention, Recognition, and Escalation Mechanisms
			Maternity and Perinatal Screening
			Newborn Screening for Congenital Conditions
			Screening for Severe Illness
			Escalation
			Training Needs for Neonatal Stabilization and Resuscitation
			Intra-Facility and Inter-facility Neonatal Transport Systems
			Equipment and Processes
			Telemedicine: Complements and Augments IFT
		Conclusion
		References
	51: Metrics to Monitor the Function and Performance of the Pediatric Rapid Response System
		Introduction
		Patient Outcomes
			Cardiac Arrest
			Respiratory Arrest/Events
			Death
			Survivorship and Morbidity Post-Critical Illness
		Parent/Family Outcomes
			Satisfaction
			Parent/Families Are Supported to Raise Clinical Concerns
		Provider Outcomes
			Satisfaction
			Preventable Events
		Process-of-Care Outcomes
			Late ICU Admission
			Intervention-Free ICU Admission
			Consultations
			Reconsultation
			Adherence
			Do Not Resuscitate (DNR) Rate
			Rapid Response Team Measures
		Practical Considerations with Data Collection
		Representation of Data
		Interpreting Data about RRS Activities, Process, and Effectiveness
		Benchmarks
		Summary
		References
	52: Rapid Response Teams in Mass Casualty Incidents
		Considerations Specific to the Management of Pediatric Mass Casualty Incidents
		Triage during a Mass Casualty Incident
		Utilization of Rapid Response Team in Mass Casualty Incidents
		Education and Training for a Pediatric Mass Casualty
		Conclusion
		References
Index