What question did this study set out to answer?

To measure and characterize adverse events surrounding rapid response team activations and ICU transfers in hospitalized children.

December 9, 2025

Association of Adverse Events With Rapid Response Team Activations in Hospitalized Children

Key Points

To measure and characterize adverse events surrounding rapid response team activations and ICU transfers in hospitalized children.
Conducted a retrospective cohort study of hospitalized patients under 18 with rapid response team evaluations.
Measured adverse events from hospital admission to rapid response team activation and during the first 48 hours post-transfer to ICU.
Performed primary chart review followed by secondary review for case classification and severity assessment.
Reviewed 699 rapid response team activations leading to 407 recorded adverse events.
Pretransfer adverse event rates were higher for emergency triaged patients (0.68 AE/RRT) compared to non-emergency (0.52 AE/RRT).
A majority of adverse events were identified as preventable, with 53.4% pre-ICU transfer and 51.6% post-ICU transfer.

Abstract

BACKGROUND/OBJECTIVES Adverse events (AEs) are frequent in hospitalized children and may lead to unplanned transfers to intensive care units (ICUs). ICU transfers may occur following activation of nonemergent or emergent assessments by a rapid response team (RRT). We sought to measure and characterize AEs around RRT activations and ICU transfers and whether different RRT triage mechanisms were associated with differences in AE rates or characteristics. METHODS We performed a retrospective cohort study of hospitalized patients younger than 18 years with RRT evaluations for and transfers to ICUs. We measured AEs from hospital admission until RRT activation (pretransfer) and during the first 48 hours following ICU transfer (posttransfer). AEs identified on primary chart review underwent secondary review by 2 independent physicians who determined case classification, severity level, and preventability. RESULTS In total, 699 RRT activations were reviewed, and 407 AEs were recorded. Pretransfer AE rates were higher for patients triaged emergently vs nonemergently (0.68 vs 0.52 AE/RRT, P = .03). Most AEs pretransfer resulted in temporary harm (National Coordinating Council for Medication Error Reporting and Prevention level F, 69.7%). Most AEs were preventable pre- (53.4%) and post-ICU transfer (51.6%). The most common clinical types of AEs were related to medications/fluids (38.3%), procedures (24.8%), and diagnosis (17.4%). CONCLUSIONS We identified high rates of AEs among patients requiring ICU triage and transfer, especially among those triaged emergently. Activation of an RRT or ICU transfer is a very high-yield trigger for AE detection.

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