Development of a Pragmatic Measure for Evaluating and Optimizing Rapid Response Systems

Pediatrics, 04/04/2012

Bonafide CP et al. – The critical deterioration rate is a valid, pragmatic proximate outcome associated with in–hospital mortality. It has great potential for complementing existing patient safety measures for evaluating rapid response systems (RRSs) performance.


  • The authors reviewed 724 medical emergency team and 56 code-blue team activations in a children’s hospital between February 2010 and February 2011.
  • By using in-hospital mortality as the gold standard, they evaluated the test characteristics and validity of this proximate outcome metric compared with a national benchmark for cardiac and respiratory arrest rates, the Child Health Corporation of America Codes Outside the ICU Whole System Measure.


  • Critical deterioration (1.52 per 1000 non-ICU patient-days) was more than eightfold more common than the Child Health Corporation of America measure of cardiac and respiratory arrests (0.18 per 1000 non-ICU patient-days) and was associated with >13-fold increased risk of in-hospital death.
  • The critical deterioration metric demonstrated both criterion and construct validity.

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