Intensity of Care in Pediatric Rapid Response Systems

Escalation and de-escalation are fundamental to the process of delivering care to hospitalized children. Preventing the adverse effects of clinical deterioration usually involves allocation of more of the available resources to patients at greater risk. Thankfully, most pediatric patients get better, most without ICU admission, and the intensity of clinical care is de-escalated in parallel with improvement leading to hospital discharge. Adaptive care delivery is at the core of effective rapid response systems. Identification of clinical deterioration marks a period when there is conscious consideration of the likelihood for a critical deterioration, accounting for antecedent risk factors such as comorbidity and deterioration history. There should be careful examination and recognition of the mechanism for deterioration with a targeted action plan. Shared situational awareness of the clinical vulnerability of the patient and nimble planning will enable rapid adaption to meet the child’s needs. In some scenarios, for patients with chronic complex needs, the plan may include maintaining the current level of care while waiting for interventions to exert their effect, e.g., infection, while still being mindful that the situation could progress to septic shock. Conversely, once the child has stabilized, there must be a careful methodical de-escalation of aspects of care delivery to adapt to the child’s needs.