How do we detect and respond to clinical deterioration in hospitalized children? Results of the Pediatric Care BefOre Deterioration Events (CODE) survey

Amanda O'Halloran, Justin Lockwood, Tina Sosa, Orsola Gawronski, Vinay Nadkarni, Monica Kleinman, Maya Dewan, Kamal Abulebda, Diane Atkins, Shilpa Balikai, Marc Berg, Robert Berg, Matthew S. Braga, Corinne Buysse, Adam Cheng, Andrea Christoff, Kelly Corbett, Allan DeCaen, Destiny LaShoto, Gabry deJongJimena del Castillo, Maya Dewan, Aaron Donoghue, Ivie Esangbedo, Stuart Friess, Sandeep Gangadharan, Orsola Gawronski, Jonathan Gilleland, Heather Griffis, James Gray, Helen Harvey, Ilana Harwayne-Gidansky, Sarah Haskell, Jennifer Hayes, Kiran Heber, Betsy Hunt, Takanari Ikeyama, Priti Jani, Monica Kleinman, Lynda Knight, Hiroshi Kurosawa, Kasper Glerup Lauridsen, Tara Lemoine, Tensing Maa, Elizabeth Masse, Luz Marina Mejia, Yee Hui Mok, Ryan Morgan, Vinay Nadkarni, Sholeen Nett, Abhay Ranganathan, Amanda O'Halloran, Michelle Olson, Gene Ong, Andrea Maxwell, Tia Raymond, Joan Roberts, Anita Sen, Sophie Skellet, Daniel Stromberg, Felice Su, Robert Sutton, Todd Sweberg, Oscar Tegg, Ken Tegtmeyer, Alexis Topjian, Claire Hanson, Javier Urbano Villaescusa, Ichiro Watanabe, Denise Welsby, Jesse Wenger, Heather Wolfe, Andrea Yeo, Pricilla Yu, Rhea Vidrine, Gim Tan, Afsaneh Pirzadeh, Angela Wratney, Kimberly DiMaria

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Systems to detect and respond to deteriorating hospitalized children are common despite little evidence supporting best practices. Our objective was to describe systems to detect/respond to deteriorating hospitalized children at Pediatric Resuscitation Quality Collaborative (pediRES-Q) institutions. We performed a cross-sectional survey of pediRES-Q leaders. Questionnaire design utilized expert validation and cognitive interviews. Thirty centers (88%) responded. Most (93%) used ≥1 system to detect deterioration: most commonly, early warning scores (83%), watcher lists (55%), and proactive surveillance teams (31%). Most (90%) had a team to respond to deteriorating patients and the majority of teams could be activated by clinician or family concerns. Most institutions (90%) collect relevant data, including number of rapid responses (88%), arrests outside intensive care units (100%), and serious safety events (88%). In conclusion, most pediRES-Q institutions utilize systems to detect/respond to deteriorating hospitalized children. Heterogeneity exists among programs. Rigorous evaluation is needed to identify best practices.

Original languageEnglish
Pages (from-to)1102-1108
Number of pages7
JournalJournal of Hospital Medicine
Issue number12
StatePublished - Dec 2023
Externally publishedYes


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